2. INTRODUCTION
85% of elbow fracture occurs at distal humerus –
out of which 55% to 75% are supracondylar
fracture
Age: 5 to 10 years; boys are more commonly
affected
The elbow joint consists of 3 joints:
ulnohumeral joint
radiocapitellar joint and
proximal radioulnar joint.
3. INTRODUCTION
Appearance and fusion of ossification centres in distal humerus
C – 2yrs
R – 4yrs
M – 6yrs
T – 8yrs
O – 10yrs
L – 12yrs
Multiples of 2
4. INTRODUCTION
Carrying angle of the elbow – due to obliquity of distal humeral physis
6 degrees in girls and 5 degrees in boys (5 to 15 degrees)
Important in assessing the angular deformities of elbow
5. SUPRACONDYLAR FRACTURE
Age: 5 to 10 years; Sex: male to female is 3:2
Mechanism of injury:
Extension type – fall on an outstretched hand with
hyperextension of elbow, forearm position (pronation
>supination) decides the rotational deformity
Flexion type – Direct trauma or fall on a flexed elbow
7. SUPRACONDYLAR FRACTURE
CLINICAL FEATURES:
History fall or trauma
Pain, swelling and external deformity (S -deformity)
around the elbow
Tenderness, decreased ROM
DNVD – brachial artery and median nerve injury
8. SUPRACONDYLAR FRACTURE
INVESTIGATIONS:
Plain radiograph of elbow AP and lateral view
Fat pad sign or sail sign – in undisplaced fracture
In displaced fracture - Assess the Gartland type,
translational and rotational deformity of distal fragment
Baumann’s angle – to assess medial angulation
9. SUPRACONDYLAR FRACTURE
TREATMENT:
Type I undisplaced fracture
Conservative treatment – immobilize elbow with splint or
cast for 3 weeks, followed by physiotherapy
Elbow at 60 – 90 deg flexion for extension type, full
extension for flexion type
Type II minimally displaced fracture
Conservative with closed reduction and splinting the elbow
for 3 weeks
May require pin fixation if unstable
10. SUPRACONDYLAR FRACTURE
CLOSED REDUCTION TECHNIQUE:
Traction Correction of translational and rotational deformity Correction of
posterior angulation by applying pressure on olecranon while flexing the elbow
pronation of the forearm
Check for distal radial pulse after reduction
Check x-rays should be obtained to confirm the reduction and to be repeated
after 1 week to rule out the loss of reduction
12. SUPRACONDYLAR FRACTURE
TREATMENT:
Type III and IV displaced fracture
Closed or open reduction with pin fixation
Splint the elbow for 3 weeks
13. SUPRACONDYLAR FRACTURE
CONTINUOUS TRACTION
Through olecranon with arm held overhead
Severely displaced irreducible fracture
If, pulse gets obliterated due to flexion >100 deg
Severe open injuries or multiple injuries of the limb
Attempt for reduction once the swelling subsides
14. SUPRACONDYLAR FRACTURE
COMPLICATIONS: Early complications:
Vascular injury – Brachial artery; causes peripheral ischemia leading to
contractures
Nerve injury – radial, median (AIN) and ulnar nerve may get injured.
Recovery usually occurs in 3-4 months. If not, it necessitates exploration.
Nerve may also get trapped between the fracture after manipulation
Ulnar nerve can be damaged iatrogenically during medial pin insertion
Compartment syndrome – as result of excessive swelling due to hyperflexion of
elbow to maintain reduction
15. SUPRACONDYLAR FRACTURE
COMPLICATIONS: Late complications:
Malunion – cubitus varus or valgus, due to faulty reduction of the
fracture
Requires Corrective osteotomies after skeletal maturity
Heterotopic ossification / Myositis ossificans
Due to vigorous manipulation or massage after trauma
Elbow stiffness – extension takes months to recover
Passive stretching should be avoided
