35. Supracondylar humeral fracture

Essay 35- Fracture of the supracondylar humerus

• What is it?
• Extraarticular fracture which is on the border between the diaphysis and the metaphysis of the humeral bone
• Encountered mainly in childhood!
• When the fracture line passes through the condyle, it is called transcondyle fracture!
• Etiology (mechanism)
• There are 2 types:
• Extension type- occurs when the patient falls with an extended ulnar joint
• Flexion type- the patient falls with elbow flexed, the distal part of the humerus moves forward (ventrally), forming an angle open forward.
• The mechanism of the supracondylar fracture is flexion!
• Symptoms
• Deformity in supracondyle region
• Edema
• Wrist drop- if radial nerve is injured
• Hemorrhage
• Phlyctenae may form
• Pathological mobility
• The ratios are disturbed between the axis of the antebrachium and the line drawn between the two condyles
• Painful passive movement of limb
• Diagnosis
• X-ray:
• Line of the fracture goes from top to bottom and from the back to the front with an angle open backwards.
• The peripheral fragment can be laterally dislocated - radially or ulnarly, and rotated
• First aid
• Approximate reduction
• The pulling of the antebrachium along the longitudinal axis has to be performed under a right angle in the ulnar joint for the extension type!
• A brachial plaster splint is placed
• Treatment
• Non-dislocated fractures- immobilized in a plaster sleeve in flexed ulnar joint up to 80° and arm is between pro and supination
• Dislocated fractures- reduced immediately under general anesthesia
• Longitudinal pulling with flexed elbow, the peripheral fragment is rotated externally
• Supra and transcondylar fractures- reduction under electronic optic screen or with X-rays
• Exploration of the brachial artery if there is no pulse
• Complications
• Volkmann’s ischemic contracture