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Paediatric Supracondylar Humerus Fracture


Supracondylar Fracture 

Patient Presentation 

     Age 6-10 years 

     MOI - Fall on outstretched hand with elbow on extension, breaks.   Olecranon serves as the fulcrum      and the stress concentrates in distal humerus. Anteriorly the perisoteum hinges.

    Pain , swelling, deformity, bruising 

    Deformity (usually S shaped ) , skin puckering 

    Compartment syndrome 

     Blood vessels spasm/ contusion/ tear/ thrombosis

    If capillary refill present , hand arm Dunlop traction done. 

    No role of Angiography , further delays the treatment. 

    Nerve Injuries, proximal fragment spike hits nerve. 

           3a Posteromedial displacement - Radial Nerve involvement 

           3b Posterolateral displacement - Median Nerve involvement 

  

Gartland and Wilkins Classification 

    Extension type fracture 

    1. Undisplaced Fracture 

    2. Displaced Fracture , posterior cortex is.                intact

    3. Displaced fracture, posterior cortex breaks 

    Flexion type occur with direct injury on elbow on flexed position. 

     95 % are extension type of fracture.

X-ray - AP image shows level of fracture, displacement . Lateral image helps classifying flextion or extension type. Fat pad sign is important. 


Management 

    Type I - Slab or Long Arm Cast 

    Type II - Slab or LAC 

                    Medial column communition requires pinning 

   Type III - Pinning or Open Reduction and  fixation 


Reduction

                   Realign coronal tilt 

                  Push anteriorly to correct extension 


Open Reduction Indications 

    Failure of closed methods 

    NV compromise 

    Open fractures 

 

Pinning

            Cross pinning - Most stable

            Lateral - Divergent most stable 

                            Convergent - less stable 

                            Parallel - least stable, tuggling

  Wilkins recommend 2 Divergent pins from lateral side , one pin high in shaft is gives the most stable construct. (Proponent of lateral pin entry )

  Assessment of Reduction 

        Anterior humeral line touches capitellum 

        Metaphyseal Diaphyseal angle < 40 degrees 

        Correction of Baumann's angle 


       Anterior Humeral Line

https://radiopaedia.org/articles/anterior-humeral-line


         Baumann Angle
https://orthofixar.com/special-test/baumann-angle/
   
           Metaphyseal Diaphyseal Angle 

https://ota.org/sites/files/2021-08/UE%206%20Distal%20Humerus%20Fractures.pdf

Common Complications 

    Pin Migration 

    Infection 

    Cubitus Varus 

    Cubitus Valgus 

    Recurvatum 

    Nerve Palsy

    Vascular Injury 

    Volkmann Ischaemic Contracture 

    Post-operative Stiffness 

    Please give your comments , if I missed anything and how can I improve. 


Also Check 

https://orthonp.blogspot.com/2020/04/algorithm-3-for-management-of-fracture.html

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