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Supracondylar Fracture of Humerus
Aka: Supracondylar Fracture of Humerus, Humeral Supracondylar Fracture, Supracondylar Fracture at Elbow
- See Also
- Pediatric Fracture
- Lateral Condyle Fracture
- Epidemiology
- Most common elbow Fractures in Children
- Age of onset ranges between 2 and 12 years of age (peaks between 5 and 8 years of age)
- Gender: Twice as common in boys
- Definition
- Distal Humerus Fracture above the epicondyles and above the physis
- Pathophysiology
- Supracondylar region of the Humerus is the weakest part of the elbow (Humerus flattens, and widens)
- Imaging
- See Elbow XRay
- Posterior fat pad sign
- Always abnormal
- May be only finding in a Type 1 supracondylar Fracture
- Anterior humeral line
- Should normally pass through middle third of capitellum
- Displaced in Type 2 and Type 3 Fractures
- Extension Fracture (most common)
- Distal fragment displaced posteriorly
- Classification
- Type 1: Non-displaced or minimally displaced
- Type 2: Distal fragment displaced and intact posterior cortex
- Type 3: Displaced and no contact between Fracture fragments
- Management
- Orthopedic referral in all cases
- Type 1 Fracture
- Splint initially
- Long Arm Splint or Double Sugar-Tong Splint
- Cast
- Longarm cast with Forearm in neutral rotation and elbow at 90 degrees
- Cast for 3 weeks followed by XRay to demonstrate supracondylar callus
- Active range of motion starts after three weeks of Casting
- Type 2 Fracture
- Splint as above and follow-up with orthopedics to determine whether Casting will be sufficient
- Open reduction and internal fixation in some cases
- Type 3 Fracture
- Open reduction and internal fixation in all cases
- Complications: Type 3 Fracture
- Malunion or poor healing
- Secondary to severe displacement, incomplete reduction, or significant Soft Tissue Injury
- Gun stock deformity
- Elbow varus angulation and loss of full elbow extension
- Compartment Syndrome
- Nerve injury (transient Neuropraxia typically resolves in weeks after injury)
- Volkmann's Ischemia with contracture
- Due to local swelling and compounded by tight Splinting or cast
- Avoid excessive compression when applying splint
- Results in a combined median and Ulnar Neuropathy
- Claw Hand and loss of grip strength at the index finger
- Median Nerve injury
- Radial Nerve injury
- Anterior interosseus nerve injury
- Motor function only: Thumb and index finger flexion
- Vascular injury
- Brachial artery injury (rare)
- References
- Eiff (2012) Fracture Management for Primary Care, Saunders, Philadelphia, p. 265-6