Supracondylar fracture

in children
5 min talk
Ext

Supracondylar fracture

Most common in children 5-8 year
the bony architecture at the supracondylar
region is weak
Most common fracture around the elbow in
children (60 percent of elbow fractures)
May be associated with a distal radius or
forearm fracture


Supracondylar fracture

Male: Female 2:1
95 percent are extension type injuries, which
produces posterior displacement of the distal
fragment
More common in children with hyper
flexibility
Classification
2 types
Extension type
Flexion type
Extension type
Distal fragment is
posteriorly displaced
95% of cases

Mechanism of injury
Caused by a fall on
outstretched hand with
hyperextension of the
elbow

Extension type
Green stick fracture may occurred
Anterior periosteum is torn
There may be a significant amount of local
bleeding and swelling
Nerves & blood vessels are contused,
compressed, or lacerated by bone fragments
& blood that infiltrates the antecubital fossa;

Extension type - Classification
Gartland Classification:

- Type I: undisplaced
- Type II: displaced with intact posterior cortex
- Type III: displaced with no cortical contact

Gartland Classification

Clinical features
Hx - FALL ON OUTSTRETCHED HAND
Failure to use upper extremity
Gross swelling & Tenderness
S-shaped deformity
Anterior Pucker sign
Crepitus
Maintained three-point relationship
Examine in Elbow injury
VASCULAR STATUS Radial artery Pulsation
[most important ] & Cap. refill
NEUROLOGICAL STATUS-
Median, Radial, Ulnar nerve
Check finger movement
Check for compartment syndrome


Pucker sign/ Brachialis sign
Brachialis Sign- Proximal Fragment
Buttonholed through Brachialis
Milking Maneuver- Milk Soft Tissues over
Proximal Spike
POST MEDIAL POST LATERAL
Type 1: Non-displaced

Note the non-
displaced fracture
(Red Arrow)

Note the posterior
fat pad (Yellow
Arrows)
Fat Pad Sign

Helpful in occult fracture with effusion
Type 2: Angulated/displaced fracture with
intact posterior cortex
Type 2: Angulated/displaced fracture with
intact posterior cortex
In many cases, the type 2
fractures will be impacted
medially, leading to varus
angulation.

The varus malposition must
be considered when
reducing these fractures,
applying a valgus force for
realignment.
Type 3
Totally displaced type
3 a post medial
3 b post lateral
Management
All suspected cases should be splinted in around
20-30 deg at elbow before sending for X-ray
Neurologic evaluation
Vascular assessment
Peripheral pulse- radial artery
Capillary filling
Doppler test
Evaluate for ipsilateral injuries- anywhere from
wrist to sternoclavicular jt.

Type 1 - Undisplaced
Simple immobilization with a long arm
posterior slab in 90 degree with cuff and collar
for 3 weeks
X-ray repeated at 5-7 days

Type 2 - displaced with
intact posterior cortex
Treatment closed
reduction under GA
Traction is applied followed
by correction of rotational
deformity
Extension deformity is
corrected with pressure by
thumb over the olecranon
May use hyperflexion
Type 3 - Totally displaced
Closed reduction & percutaneous K. wire
fixation
Open reduction & K. wire fixation (if the
patient has indication for Sx)
Percutaneous K. wire fixation
Indications for Surgery
Volkmanns Ischemia
Irreducible fracture
Vascular injury
Open fractures
Supracondylar Fractures: Associated
Injuries - Nerve

Nerve injury incidence is high, between 7 and 16 %
(radial, median, and ulnar nerve)

Anterior interosseous nerve injury is most commonly
injured nerve

Supracondylar Fractures: Associated
Injuries - Bone
5% have associated
distal radius fracture
Physical exam of distal
forearm
Radiographs if needed
If displaced pin radius
also
Supracondylar Fractures: Associated
Injuries - Vascular
Vascular injuries are rare, but pulses should always
be assessed before and after reduction

In the absence of a radial and/or ulnar pulse, the
fingers may still be well-perfused, because of the
excellent collateral circulation around the elbow

Doppler device can be used for assessment

Beware of Compartment Syndrome
Supracondylar Fractures:
Complications
Malunion cubitus varus
Volkmanns ischemia
Contracture
Myositis Ossificans
Vascular injury
Loss of reduction
Loss of elbow motion
Pin track infection
Neurovascular injury with
pin placement
Myositis Ossificans
Flexion type
5-10% of all
supracondylar fracture
posterior cortex fails
first
resulting fracture has
anterior displacement
of the distal fragment


Mechanism of injury
occurs from fall
with elbow flexed
as it hits the
ground

Flexion type
Flexion type
Soft tissue swelling and damage are usually
much less than in the extension type and
neurovascular complications are rare
Ulnar nerve palsy occurs in some cases;
injured by the sharp spike of proximal
fragment

Flexion type - Classification
Can use a similar classification scheme as
extension type injury: types I, II, III

Type I: undisplaced or minimally displaced
Type II: integrity of anterior cortex remains,
but with anterior displacement of distal
fragment
Type III: complete displacement
Flexion type - Management
Type I: cast/splint
Type II: reduce and cast in extension,
may need pinning
Type III: usually requires open reduction and
percutaneous pins
Flexion type - Pinning
Referrence
http://www.wheelessonline.com
http://www.slideshare.net/Naufal_Alwi/supracond
ylar-fractures-inchildren
fracture and dislocation of the
upper extremities in children .

Thank You!!!