Supracondylar Fracture of Humerus;

a Case Presentation and a Brief Review

Farbod Zahedi TajrishiBabol University of Medical Sciences

Nov. 2015

Case

• 11-year-old school-boy• Falling on outstretched hand while playing in

school• Referred with his mother as company• Had a radiograph with them which showed

supracondylar fx. of left humerus

Presentation and Physical Exam

• Pain, tenderness, inflation & deformity in the distal part of left arm (elbow region)

• Other extremities were NL• NL Color & temp. of the affected extremity • NL radial, ulnar & brachial pulses• NL Capillary filling• NL radial, ulnar, median & musculocutaneous

nerves (motor & sensory)

Orders and Taken Actions

• IV line• AP & lat. X-ray of left elbow• Full-length x-ray of left arm & forearm• Reduction• Splint (in neutral position)• Ice pack, elevation• N/V check every 1 hour• NPO and OR list registration

Diagnosis and typing

• Supracondylar fx. of left humerus• AO classification: 13A2• Extension type• Angulation + / displacement + / rotation +

(posterolateral movement)

Epidemiology

- Mostly seen in children (mostly boys)- Only 3% of all fractures in adults- Peak age: 5-7- Left or non-dominant side predominates

Etiology

- Supracondylar area is vulnerable because:1. the bone in this area is less cylindrical2. Laxity of ligaments permits hyperextensionAnd …- Two types:1. Extension type (more common)2. Flexion type

Clinical Presentation

- Elbow deformity- Edema- Ecchymosis- Tenderness in fx. Site- Crepitation- Limited motion of elbow

Treatment- Splint / long cast if no displacement- Surgical fixation with pin if displaced, 3-week cast after

surgery, 3-week sling after removing the cast!! Elevation is necessary after casting or surgery in order to regulate bloodstream and reduce inflation.

Complications- Compartment syndrome

- Brachial artery injury -> Volkmann Ischemic Syn.

Complications

- Nerve injury (usually reversible) : median & radial in ext. type / ulnar in flex. type

- Malunion -> Cubitus Varus deformity (tx: surgery)

Complications

• Myositis Ossificans

Thanks for your time and attention

Farbod Zahedi TajrishiNov. 2015