Trauma conference supracondylar humerus fracture

1. Dr. Failagao, Nel John Roy Bereber
Level 1 Resident

2. General Data:
Name: Villanueva, Criyz Nikko
Hosp No. 1168133
Age/Sex/CS: 6/M/Ch
Address: Dumangas, Iloilo

3. HISTORY
• NOI Fall
• TOI 5pm
• POI Dumangas
• DOI 10/16/22
• Patient was playing when he fell on his
outstretched hand thus sustaining his injuries
• 1 day PTA, patient sought consult at OPD and was
advised for Admission.
• (+)Pain/Swelling/LOM of left elbow complex

4. • Fracture Closed Complete Displaced Lateral
Condyle Humerus, Left
Secondary to Fall
AO 13B1.1
Milch Type II
Weiss type 3

11. PLAN
• For Close vs Open Reduction, Multiple Pinning
of Lateral Condyle Left
• Approach: Lateral Approach to the Elbow
• Implants:K-wire 0.045/0.062

12. DISCUSSION
• Transphyseal, intraarticular injuries
• Second most common operative elbow injury
in children

13. ANATOMY

14. BLOOD SUPPLY
Care must be taken to
ensure that all soft tissue dissection
occurs anteriorly to
avoid the posterior blood supply of the
distal fragment.
Brachial artery; Anteriorly in the
antecubital fossa-anastomotic vessels
that course posteriorly

15. ANATOMY
• Extensors And Supinator
• Capitellum is the first secondary ossification
center of the elbow to appear (~2YO)
• The lateral epicondyle is the last (12-13YO)
• Two ossification centers fuse at skeletal
maturity

16. MECHANISM OF INJURY
1) Elbow is forced into varus
2) Valgus force in which the
radial head directly pushes
off the lateral condyle
3) Extensor muscles and
lateral collateral ligaments,
applies an avulsion force to
the lateral condyle
4) Fracture line extends to
the trochlear notch
(bottom right), the elbow
becomes unstable.

17. MILCH CLASSIFICATION
TWO GROUPS DEPENDING ON THEIR RELATIONSHIP WITH
THE TROCHLEAR GROOVE
Type II Fracture line is lateral to trochlear groove (less common,
elbow is stable as fracture does NOT enter trochlear
groove)
Type II Fracture line extends medially into trochlear groove (more
common, more unstable)

18. JAKOBS CLASSIFICATION

19. WEISS’S
CLASSIFICATION
< 2mm,
indicating intact
cartilaginous
hinge
Tx: Casting
> 2 mm < 4
displacement,
intact articular
cartilage on
arthrogram
Tx: Closed
reduction and
fixation
4 mm, articular
surface disrupted
on arthrogram
Tx: Open reduction
and fixation

20. COMPLICATIONS
The most common complications after lateral
condyle fracture :
1. Cubitus Varus
2. Lateral Spur Formation
3. Delayed Union
4. Nonunion With Or Without Cubitus Valgus
5. Growth Arrest
6. Fishtail Deformity Of The Distal

21. Delayed Union
1. Minimally displaced fracture that does not
heal with 6 weeks of immobilization
2. Untreated fracture that is initially seen more
than 2 weeks (but by convention <3 months)
after the injury.

22. Delayed Union and Nonunion
Several factors contribute to the difficulty in
achieving union of lateral condyle fractures.
A. Fracture is intraarticular and thus is
constantly exposed to synovial fluid.
B. Lateral condyle has a poor blood supply
C. If not immobilized, there is constant motion
at the fracture site from the pull of the wrist
extensors on the distal fragment.