Fracture

1. SUPRACONDYLAR
FRACTURE HUMERUS
DR. VEERAMANI.G,
ASST PROFESSOR,DEPT OF ORTHOPAEDICS,
GOVT MEDICAL COLLEGE, TIRUPPUR

2. ANATOMY

3. DEFINITION
 Also called as Malgaigne’s fracture
 Fracture line passes just proximal to the
bone masses of trochlea capitulum and
often runs through the apices of
coronoid and olecranon fossae or just
above the fossae or through
metaphysis of humerus
 The fracture line is generally
transverse in frontal plane

4. EPIDEMIOLOGY
 AGE:PEAK AGE:5-7 YRS
 SEX:BOYS>GIRLS
 SIDE:LEFT>RIGHT
 NERVE INJURY:RADIAL>MEDIAN>ULNAR
 VASCULAR INJURY:1%(BRACHIAL ARTERY)
 OPEN INJURY:<1%

5.  Remodeling of bone causes decreased AP diameter in the
SUPRACONDYLAR region, making this area susceptible to injury
 Ligamentous laxity increases the likelihood of hyper extension injury
 Anterior capsule is thicker and stronger than posterior capsule. In
extension,the fibers of anterior capsule is taut, serving as fulcrum by
which olecranon becomes firmly engaged in olecranon fossa. With
extreme force ,hyperextension may cause olecranon process to
impinge on superior olecranon fossa and SUPRACONDYLAR region

6. MECHANISM OF INJURY

7. EXTENSION TYPE
 FALL ON OUTSTRECHED HAND
 ELBOW –HYPEREXTENDED
 FOREARM-PRONATED/SUPINED

8. FLEXION TYPE
 FALL DIRECTLY ON THE ELBOW

9. CLASSIFICATION

10. CLASSIFICATION

11. TYPE I
 Non
displaced/Minimally
displaced (<2mm)
 Posterior Fat pad sign

12. TYPE II
 Displaced #>2mm
 AHL goes anterior to
capitulum
 Posterior cortical
contact intact

13. TYPE III
 No meaningful cortical
contact between two
fragments

14. TYPE IV
 Multidirectional instability
 Diagnosed
intraoperatively In
extension capitulum lies
posterior to AHL & In
flexion capitulum lies
anterior to AHL

15. CLINICAL EVALUATION
 In most cases, children children will not move
the elbow if a fracture is present, although
this may not be the case for non-displaced
fractures.although this may not be the case
for non-displaced fractures.
 Swelling about elbow is a constant feature,
develop within first few hrs.
 S shaped deformity
 Distal humeral tenderness
 Anterior plucker sign +ve

16. S-Shaped deformity

17. PUCKER SIGN

18. RADIOGRAPHIC EVALUATION
 RADIOGRAPHIC VIEWS
 AP
 LATERAL
 OBLIQUE
 AXIAL(JONES)

19. AP VIEW
 BAUMANN’S ANGLE
 HUMERO ULNAR ANGLE
 METAPHYSIO DIAPHYSEAL ANGLE

20. BAUMANN’S ANGLE
 Baumann’s angle is formed by a line
perpendicular to the axis of the humerus, and
a lateral physeal line
 There is a wide range of normal value, and it
can vary with rotation of the radiograph
 The Baumann angle is good measurement of
any deviation of distal humerus`s angulation
 In this case, the medial impaction and varus
position alters the Bauman’s angle.
 Normal avg 72 *

21. ANTERIOR HUMERAL LINE
 This is drawn along the anterior
humeral cortex.
 It should pass through the junction
of anterior & middle 3rd of
capitellum.

22. RADIOGRAPHIC SIGNS

23. MANAGEMENT
 Long arm cast
 CMR F/B PIN FIXATION
 ORIF
 TRACTION MANAGEMENT

24. TYPE I
 Simple long arm splint for 3-7days
 ELBOW 60-90 flexion & forearm in neutral
⁰
position
 If no displacement after 1 week splint is
converted to long arm cast
 If displaced # is reduced f/b casting/pinning
done

25. TYPE II
 CMR F/B SELECTIVE PINNING WITH SUPPOTIVE
LONG ARM SPLINT

26. TYOE III AND IV
 Unstable
 Periosteum is torn
 No cortical contact between two fragments
 Associated with soft tissue injury
 Reduction (closed/open)
 Stabilisation (PINS/TRACTION MANAGEMENT)

27. Reduction technique
 Traction and counter traction
 Milking maneuver
 Correction of medial/lateral displacement
 Correction of rotational deformities
 Correction of posterior displacement by flexion maneuver
 ELBOW held in hyper flexion
 Forearm held in pronation/supination

28. Reduction technique

29. PIN FIXATION
 2 Lateral pins (Divergent/Parallel)
 2Crossed pins
 3 Lateral pins
 2 Lateral and 1 medial pins

30. PIN FIXATION

31. TRACTION MANAGEMENT
 Skin Traction & Skeletal Traction
 Methods:
 Side arm skin Traction (Dunlop)
 Overhead Skeletal Traction

32. FLEXION TYPE
 Rare,only 2%
 Distal fragment displaced anterior, flexed
 ULNAR nerve injury is common
 Reduced WITH extension

33. MANAGEMENT

34. COMPLICATION
 IMMEDIATE COMPLICATION: at the time of
Fracture
 EARLY COMPLICATION:within first 2-3days
 LATE COMPLICATION:Weeks to months after
Fracture

35. IMMEDIATE COMPLICATION
 INJURY TO BRACHIAL ARTERY
 NERVE INJURY

36. EARLY COMPLICATION
 VOLKMANN’S ISCHAEMIA
 COMPARTMENT SYNDROME

37. LATE COMPLICATION
 MALUNION:CUBITUS VARUS/VALGUS
 NON UNION
 VOLKMANN’S ISCHEAMIC CONTRACTURE
 MYOSITIS OSSIFICANS
 ELBOW STIFFNESS

38. CUBITUS VARUS DEFORMITY
 GUNSTOCK DEFORMITY
 The distal fragment is tilted medially
and in internal rotation
 Hyper extension at elbow along with
limitation of flexion
 Mild deformity –No treatment
 Severe deformity –Corrective
osteotomy(French osteotomy)

39. Lateral closing wedge osteotomy

42. THANK YOU