Treatment and complications of supracondylar fracture of humerus

1. J.B.S.Nandita Jyothi
Roll no.77

2. • For undisplaced fracture- immobilized in an above
elbow plaster slab with the elbow 90° in flexion

3. For displaced fractures:
closed reduction and percutaneous K wire fixation
or
open reduction and K wire fixation
or
continuous traction are the available options

4. 1) Traction with elbow in flexion
– counter traction applied at arm-
gradual extension of elbow and
suppination of forearm- proximal
and medial-lateral displacements
2) Flexion in traction- thumb on
olecranon- flex elbow while
maintaining traction
3) Pressure over olecranon-
forward into flexion- observe
radial pulse obliteration- extend
and apply slab in the position
That pulse returns

5. When elbow flexed beyond 90° while tracture is being
applied simultaneously while olecranon is pushed into
flexion- there occurs locking- the intact periosteum and
triceps act as internal splint and stabilize reduction

6. Used when it is not possible to achieve a good position by
closed methods or when it gets redisplaced after reduction
Used as first line treatment when exploration of brachial
artery is required to check for injury

8. Immediate complications- occuring at the time of fracture-
injury to brachial artery, injury to nerves
Early complication- wihin 2-3 days- volkmann’s ischemia
Late complication – weeks to months after fracture-
malunion, myositis ossificans, volkmann’s ischemic
contracture

9. • Injury to brachial artery by
proximal fragment –
collaterals maintain blood
flow but supply to flexor
muscles is compromised
leading to volkmann’s
ischemia
• Injury to median and radial
nerve- spontaneous recovery
occurs in most cases

10. Volkmann’s ischemia: ischemic injury to flexor
compartment of forearm- most commonly affected muscles
are flexor pollicis Longus and flexor digitorum profundus
as anterior interosseous artery is an end artery
Signs- severe pain in forearm, pain in flexor aspect of
forearm when fingers are extended
Treatment- remove splint, elevate forearm move fingers, if
no improvement within 2 hours- do urgent decompression
by fasciotomy

11. Malunion – most common complication- when fracture
unites with distal fragment tilted medially and in internal
rotation- results in cubitus varus deformity or gunnstock
deformity
Treatment- range of movement is not restricted usually,
supracondylar corrective osteotomy done in case of severe
deformity

13. Myositis ossificans – ectopic new bone formation in elbow – poor
prognosis
Volkmann’s ischemic contracture- muscles are replaced by fibrous
tissue which contracts and draws wrist and fingers into flexion.
 Clinical features- atrophy of forearm, flexion deformity of wrist and
fingers
 Volkmanns sign- possible to extend fingers at interphalyngeal joint
only when wrist is flexed
 Treatment- passive stretching of muscles using turn buckle splint(
Volkmann’s splint), maxpage operation- flexor muscles released from
attachment at ulna, bone operations- shortening of forearm bones

14. THANK YOU