200401 flexion type of supracondylar fracture

Short presentation on the technique of reduction of Flexion type of supracondylar fracture

1. Flexion Type of Supracondylar Fracture Prepared by Dr Madan Mohan B Based on a JBJS Review Anmol Sharma, MBBS, MS Investigation performed at the Government Medical College and Hospital, Chandigarh, India JBJS REVIEWS 2019;7(4):e6 · http://dx.doi.org/10.2106/JBJS.RVW.18.00114

2. A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures. The injury is caused by a direct fall on the point of the elbow, causing hyperflexion at the elbow, rather than by a fall on an outstretched hand, which is the mechanism in an extension-type fracture. The ulnar nerve is at higher risk of injury in this fracture by the spike of the proximal fragment or by entrapment in the callus.

3. This fracture is inherently unstable, leading to difficulty in maintaining reduction intraoperatively and difficult Kirschner wiring in the extension position in which the reduction is achieved. Kirschner wiring can be done in a flexed position of the elbow by utilizing a push-pull method, a temporary transolecranon pin, or a Kirschner wire as a joystick in the distal fragment to achieve and maintain reduction before the insertion of the final pins.

4. Fig. 1-A Prereduction with a rolled towel used as a fulcrum. Fig. 1-B Push with overreduction into extension. Fig. 1-C Pullback to align the anterior humeral line with the middle third of the capitellum.