Discussion Supracondylar Fracture of Distal Humerus

Age 6- 10 years

common in boys.

Fall on outstretched hand (FOOSH) - common mechanism of injury.

Break in periosteum anteriorly , hinge force posteriorly.



Extension fracture in 95 % of cases
Flexion type fracture in 5 % of cases .

Extension type fracture classification of Gartland and Wilkin's

1. Undisplaced fracture

2.Displaced fractures , posterior cortex intact

3.Displaced fracture , posterior cortex breaks




Flexion type
direct injury on elbow on flexed position.



Patient presentation

1. history of trauma

2.pain , swelling , deformity , bruises on arm

3.Deformity - S-shaped , puckering ,

4.compratment syndrome

( It may be due to vessel spasm , contusion , tear , thrombosis
If capillary refill present , hand arm Dunlop traction given. )

5.Nerve injuries
 proximal fragment spike hits the nerve.
type 3a posteromedial displacement - radial nerve injured

 type 3b with posterolateral displacement -  ulnar nerve affected.

flexion type injury results in Ulnar nerve injury


X-ray description

AP film
  s/c fracture , fracture line oblique or transverse through olecranon fossa

   displaced or undisplaced

Lateral  - fracture displacedment direction , fat pad signs


Tr.

1.Type I - Slab / LAC

2. Type II - Slab / LAC
 
     Medial column communition - pinning

3. Pinning /Open

Reduction - realign coronal tilt

                    push anteriorly to correct extension .

X-ray assessment

Lateral Landmarks
posterior margins of coronid fossa
anterior margins of olecranon fossa

  Shaft condylar angle
  angulation of 40 degrees between the long axis of humerus and long axis of lateral condyle

Supracondylar and Lateral Condyle Fractures of the Humerus in ...


Humeral ulnar angle - best resembles the carrying angle of elbow .


AP Film

Bauman's angle - 64 to 81 degrees
Radiography of the elbow supracondylar fracture. Baumann's angle ...



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Open reduction indications
failure of closed methods

NV compromise

open fractures

Pining Types
Most stable - Cross Pinning

Lateral - Divergent

               Convergent - less stable

              parallel - least stable , toggles

Wilkin's Recommendation. - 2 divergent pins from lateral side ; of them one pin high in shaft leads to most stable fixaiton . He is a proponent of lateral pin entry.













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