Supracondylar fracture of humerus

Supracondylar fracture of humerus by Dr Bipul Borthakur

1. Supracondylar fracture humerus DR. bipul borthakur Professor, Department of orthopaedics, smch

2. INTRODUCTION 85% of elbow fracture occurs at distal humerus – out of which 55% to 75% are supracondylar fracture Age: 5 to 10 years; boys are more commonly affected The elbow joint consists of 3 joints: ulnohumeral joint radiocapitellar joint and proximal radioulnar joint.

3. INTRODUCTION Appearance and fusion of ossification centres in distal humerus C – 2yrs R – 4yrs M – 6yrs T – 8yrs O – 10yrs L – 12yrs Multiples of 2

4. INTRODUCTION Carrying angle of the elbow – due to obliquity of distal humeral physis 6 degrees in girls and 5 degrees in boys (5 to 15 degrees) Important in assessing the angular deformities of elbow

5. SUPRACONDYLAR FRACTURE Age: 5 to 10 years; Sex: male to female is 3:2 Mechanism of injury: Extension type – fall on an outstretched hand with hyperextension of elbow, forearm position (pronation >supination) decides the rotational deformity Flexion type – Direct trauma or fall on a flexed e lbow

6. SUPRACONDYLAR FRACTURE GARTLAND CLASSIFICATION :

7. SUPRACONDYLAR FRACTURE CLINICAL FEATURES: History fall or trauma Pain, swelling and external deformity (S -deformity) around the elbow Tenderness, decreased ROM DNVD – brachial artery and median nerve injury

8. SUPRACONDYLAR FRACTURE INVESTIGATIONS: Plain radiograph of elbow AP and lateral view Fat pad sign or sail sign – in undisplaced fracture In displaced fracture - Assess the Gartland type, translational and rotational deformity of distal fragment Baumann’s angle – to assess medial angulation

9. SUPRACONDYLAR FRACTURE TREATMENT: Type I undisplaced fracture Conservative treatment – immobilize elbow with splint or cast for 3 weeks, followed by physiotherapy Elbow at 60 – 90 deg flexion for extension type, full extension for flexion type Type II minimally displaced fracture Conservative with closed reduction and splinting the elbow for 3 weeks May require pin fixation if unstable

10. SUPRACONDYLAR FRACTURE CLOSED REDUCTION TECHNIQUE: Traction  Correction of translational and rotational deformity  Correction of posterior angulation by applying pressure on olecranon while flexing the elbow  pronation of the forearm Check for distal radial pulse after reduction Check x-rays should be obtained to confirm the reduction and to be repeated after 1 week to rule out the loss of reduction

11. SUPRACONDYLAR FRACTURE

12. SUPRACONDYLAR FRACTURE TREATMENT: Type III and IV displaced fracture Closed or open reduction with pin fixation Splint the elbow for 3 weeks

13. SUPRACONDYLAR FRACTURE CONTINUOUS TRACTION Through olecranon with arm held overhead Severely displaced irreducible fracture If, pulse gets obliterated due to flexion >100 deg Severe open injuries or multiple injuries of the limb Attempt for reduction once the swelling subsides

14. SUPRACONDYLAR FRACTURE COMPLICATIONS: Early complications: Vascular injury – Brachial artery; causes peripheral ischemia leading to contractures Nerve injury – radial, median (AIN) and ulnar nerve may get injured. Recovery usually occurs in 3-4 months. If not, it necessitates exploration. Nerve may also get trapped between the fracture after manipulation Ulnar nerve can be damaged iatrogenically during medial pin insertion Compartment syndrome – as result of excessive swelling due to hyperflexion of elbow to maintain reduction

15. SUPRACONDYLAR FRACTURE COMPLICATIONS: Late complications: Malunion – cubitus varus or valgus, due to faulty reduction of the fracture Requires Corrective osteotomies after skeletal maturity Heterotopic ossification / Myositis ossificans Due to vigorous manipulation or massage after trauma Elbow stiffness – extension takes months to recover Passive stretching should be avoided

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