| ID | 249 |
|---|---|
| Name | SUPRACONDYLAR FRACTURE OF THE HUMERUS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis: X-ray of the elbow- Anteroposterior and lateral view. |
| Investigations | |
| Management | |
| Introduction | Supracondylar fracture of the humerus is one of the commonest and most important fractures of childhood. It should always be regarded as potentially dangerous because of the risk of injury to the brachial artery. Common age group- male, 5-8 years. Mechanism of injury: Fracture with posterior displacement: About 95% of fracture cases create posterior angulation or displacement, which is usually due to a fall on the outstretched arm. The distal fragment is pushed backwards and twisted inwards; the jagged end of the proximal fragment pokes into the soft tissues anteriorly, sometimes injuring the brachial artery or median nerve. Fracture with anterior displacement: This is very rare, and thought to be due to direct violence, causing a fall on the point of the elbow with the joint in flexion. |
| History | |
| Etiology | |
| Clinical Features | |
| Preventions | |
| Treatment | Treatment: A. Undisplaced fractures- in children, require protection in plaster, not more than 3 weeks. B. When the fragments are displaced- the patient is referred to specialized hospital for- 1 Manipulative reduction under general anesthesia 2. After reduction the limb is immobilised in plaster with the elbow fixed a little more acutely than the right angle. Precaution - a careful watch should be kept on the condition of the cir culation in the forearm and hand. The plaster should be cut away at the radial side of the wrist to allow the surgeon to feel for the radial pulse. Reduction under G/A: 1. Surgeon shakes hand, elbow flexed. 2. Assistant hold the arm from behind. 3. Surgeon pulls forward (traction), assistant surgeon pulls backwards (counter traction) - thus dorsal displacement corrected. 4. For correction of pronation- forearms extended and supinated. 5. For correction of dorsal angulation- thumb is placed over olecranon, pressure is given with gradually flexing the hand. Radial pulse is felt. Immobilization: 1. Immobilization is primarily done by a back slab plaster and cotton and calf sling. 2. When oedema subsides- a full plaster from midarm to metacarpo-phalangeal joint is applied and kept for 3 weeks (for children). |
| Complications | |
| Prognosis | |
| Types | |
| Classification | Classification: Supracondylar fractures can be classified as (Wilkins: 1984): Type I- an undisplaced fracture. Type II- an angulated fracture with the posterior cortex still in continuity; HA- being less severe and merely angulated; IIB- being more severe and both angulated and malrotated. Type HI- a completely displaced fracture |
| Observation | |
| Pathology |
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