1) Supracondylar fractures of the humerus are common in children under 10 years old due to the weak bony architecture in the supracondylar region. 2) Gartland's classification is used to classify these fractures in children into Type I (undisplaced), Type II (displaced but with intact posterior cortex), and Type III (displaced with no intact posterior cortex). 3) These fractures most often result from a fall onto an outstretched hand causing hyperextension of the elbow, and can be either extension-type or flexion-type based on the mechanism of injury.

1. Supracondylar fracture of the
humerus
Akana mohan phaneendra
Final M.B.B.S part-2
8th semester
12th august 2016

2. Distal humerus anatomy
• Medial epicondyle:
Proximal to trochlea
• Lateral epicondyle :
Proximal to capitulum
• Radial fossa:
Accomodates margin of
radial head during
flexion
• Coronoid fossa:
Accepts coronoid process
of ulna during flexion

3. Quick review of statistics
• Age : 1st decade , 5-8 years , 84% cases <10 years
• Sex : boys 63.6%
• Sides : (L)-58.6% , (R)-42.4%
• Open fracture : 2.3%
• Extension type : 97.7%
• Flexion type : 2.3%
• Nerve injury : 7%
– Radial nerve - 45%
– Median nerve - 32%
– Ulnar nerve - 23%

4. Vital facts of pathological anatomy
Why common in children <10 years of age???
Bony architecture at the supracondylar region is weak &
vulnerable because in this region
• Bone is remodelling
• It is less cylindrical
• Metaphysis is just distal to 2 fossae , coronoid & radial
• Here the cortex is thin
• Anterior cortex has a defect in the area of coroniod
fossa
• Laxity of ligaments permits hyperextension at the
elbow

6. Predisposing factors for juvenile
Supracondylar fracture are
• Ligamentous laxity at the elbow
leads to hyperextension
• Hyperextension converts linear force into bending force
• Olecranon concentrates this force to the weak condylar
area
• Anterior capsule is taut
• Bony architecture of supracondyalr area

8. GARTLAND’S CLASSIFICATION (CHILDREN):
• TYPE I : Undisplaced
• TYPE II : Displaced,but posterior cortex is intact
• TYPE III : Displaced, but no intact posterior cortex &
the distal fragment could be either displaced;
A)posteromedial or
B) posterolateral.

9. MECHANISM OF INJURY
• Extension type :
Fall on outstretched hand
Elbow hyperextended
Forearm pronated or
supinated

10. MECHANISM OF INJURY
• Flexion type:
Fall directly on the
elbow rather than
out stretched hand

11. CHARECTERISTIC CLINICAL SIGNS IN SC #
• Arm is short , forearm is normal in length
• Gross swelling , and tenderness
• Crepitus is present but should not be elicited for
fear of increasing the pain and damaging the
neighbouring neurovascular structures
• Relationship between three bony points is
maintained

13. • S-shaped deformity
• Dimple sign due to one of the spikes of proximal
fragment penetrating the muscle and tethering the skin
• “soft spots” is
an effusion beneath
anconeus muscle
• Movements of
elbow both active &
passive -- decreased

16. X-RAY OF ELBOW
Antero-posterior view:
• BAUMANN’S ANGLE:
Angle b/n horizontal
line of elbow and line
drawn through lateral
epiphysis & long axis of the arm
• Angle b/n long axis of humerus & transverse axis of
elbow is normally 90 degrees
<90 degrees  cubitus varus
> 90 degrees  cubitus valgus

17. LATERAL VIEW:
• TEAR DROP SIGN : Disturbed in
Supracondylar fracture
• Normally , there is an angulation of 40 degrees b/n
long axis of humerus & long axis of lat. Epicondyle

18. • ANTERIOR HUMERAL LINE:
A line drawn along
ant. border or distal humeral shaft passes
through the middle 1/3rd
of capitulum.
If it passes through ant.
1/3rd ,it indicates posterior
displacement of fragment

19. • FAT PAD SIGN:
The olecranon process is deep & thus the fat pad here lies totally
contained within the fossa
Not seen on the lateral radiograph of the elbow at 90 degrees
Distension of the capsule with an effusion due to trauma or
infection causes the olecranon pad to be visualized as a
radiolucent gap

20. • CRESCENT SIGN:
Here the normal radiolucent gap of the elbow joint is
missing & a crescent –shaped shadow due to the
overlap of the capitulum’s over the olecranon is evident
& indicates either varus or valgus tilt of the distal
fragement

21. • THE CORONOID LINE :
A line directed proximally along the anterior border
of the coronoid process of the ulna should barely
touch the anterior portion of the lateral
condyle.posterior displacement of the lateral
condyle will project the ossification center posterior
to this line

22. • FISH-TAIL SIGN:
Due to rotation of the distal fragment,the anterior
border of the proximal fragment look like sharp
spike

23. RADIOLOGICAL POINTS
• Coronal tilt of the distal fragment : usally varus tilt
rarely valgus indicated on radiography by:
– Crescent sign
– Baumann’s triangle
• Horizontal rotation of the distal fragment:indicated
by fish tail sign
• Posterior displacement of the distal fragment:
– Loss of tear drop sign
– Coronoid line
– Fat pad sign
– Anterior humeral line

24. MANAGEMENT
• CONSERVATIVE MANAGEMENT
• TRACTION METHODS
• SURGERY : PCIF & OPEN REDUCTION
• CLOSED REDUCTION & PERCUTANEOUS INTERNAL
FIXATION
• OPEN REDUCTION

27. COMPLICATIONS
• CAUSING FUNCTIONAL IMPAIRMENT
• ONLY COSMETIC SEQUELAE
• FUNCTIONAL IMPAIRMENT:
– NEUROLOGICAL INVOLVEMENT – 7%
– RADIAL NERVE – postero-medial displacement
– MEDIAN NERVE – posterior displacement
– ANTERIOR INTEROSSEUS NERVE – posterolateral
displacement of distal fragment
– ULNAR NERVE – overhead skeletal traction & in flexion
type of SC #

28. – VASCULAR INJURY
• 0.5 to 1 %
• Common with extension type
• Direct injury to brachial artery
– LOSS OF MOBILITY:
• Avg. loss of flexion is 4 degrees due to posterior
displacement,which unites in that position causing mechanical
block of flexion
– MYOSITIS OSSIFICANS
• Seen in manipulative closed reduction & open reduction

29. REFERENCES:
• ESSENTIAL ORTHOPAEDICS(5th edition)—
maheswari & mhaskar
• TEXT BOOK OF ORTHOPAEDICS(4th edition) –
john ebnezar

30. THANK ‘Q’ EVERY ‘1’
THE IS TIME
FACT ONLY
DECIDES THAT
EVERYTHING
-anonymous