S/C Fracture , a must know situation







X-RAY Photograph showing type III Supracondylar Distal Humerus Fracture in a child 

Management 
Rule out other injuries 
Assess for presence of open injury 
Assess distal neurovascular (hand colour, capillary refill of finger tips, radial pulse, sensation in specific dermatomes, motor function in ulnar, median, radial and AIN injuries )
Analgesics
Temporary back slab, continue NPO 
 OT set up and make C-arm ready
 CR- technique
       Continuous traction in 20 degree flexion, several minutes 
       Correct vlagus/varus and rotational deformity
       Flex arm
        Pronate forearm to lack fragments     
        Insert a lateral wire (1.6mm ) first
        Extend arm a little to plan a mini open approach to medial side
        Bend and cut wires in clinic in 3-4 weeks
        splint arm in back slab in near extension
        reassess for perfusion of hand and watch for compartment syndrome

If we dont  feel pulse after pining , what to do next ?
        assess colour and warmth of hand , capillary refill time
        for a pink warm hand with adequate capillary refill of finger tips, i would monitor situation with a         regular review. 
        Artery in spasm (if), will lead to loss of pulsation.
        If hand is white and CR reduced,i will remove splint,extend elbow and see situation.
        If not contact vascular /plastic surgeon for urgent review as artery has been caught up in it and has         been occluded by reduction.

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