supracondylar humerus fractures are most common in children.presenting you details of supracondylar fractures & its treatment modalities.

1. Supracondylar humerus fractures
in children
By Dr. Ranveer Patel
Orthopaedic Surgeon,
Shreeji Orthopaedic Care

2. ..
• A Supracondylar humerus fracture is a fracture
of the distal humerus just above the elbow
joint.
• The fracture is usually transverse or oblique &
above the medial & lateral condyles &
epicondyles.

3. Elbow anatomy
• The Elbow is a modified hinge joint consists of
3 joints : ulnotrochlear ,radiocapitellar,&
proximal radioulnar joint.
• Nerves around elbows are radial nerve,ulnar
nerve & median nerve
• Normal range of movements are 0 to 150
degrees flexion,80-90 degrees supination &
70-80 degrees pronation

4. ,,
• Supracondylar region is more vulnerable to
fracture because
o Bone remodelling
o Thin cortex
o Opposing tension of triceps & flexors
o Ligament laxity
o Less cyclindrical

5. Epidemiology
• Commonest injury around the elbow
• Age : < 10 yrs. (5-8 yrs)
• Sex : more common in boys
• Usually fall from height
• More common on left side
• Frequently sch # are displaced.
• Nerve injuries are common

6. Mechanism of injury
• Fall on outstreched hand
• Fall on point of a flexed elbow

7. Classification
• Extension type (95-98%)
 Gartland’s classification in children:
 Type 1: Undisplaced
 Type 2: mild displacement with intact posterior
cortex
2A: merely angulated distal fragment
2B: fragment is both angulated &
malrotated
 Type 3: Complete displacement without intact
posterior cortex
• Flexion type: (2-5%)

8. Type 1

9. ..

10. Type 3

11. ..

12. ..

13. Clinical symptoms & signs
• Pain
• Gross swelling & tenderness
• S shaped deformity
• Anterior pucker sign
• 3 point bony relationship well maintained

14. Diagnosis
• Mainly clinical
• Investigations:
o X-ray elbow joint (AP/Lateral view):
• when posterior displacement of distal
fragment :
-Fat pad sign
-Displaced anterior humeral line
-Displaced coronoid line
-Loss of tear drop sign

15. X-ray signs
• Coronal tilt of distal fragment (varus
deformity)
Increased Baumann’s angle
Disrupted metaphyseal-diaphyseal angle
Disrupted humero-ulnar angle
Crescent sign
• Horizontal rotation of distal fragment
Fish-tail sign

16. Treatment
• Gartland type 1:
immobilisation in cast for 3-4 weeks
• Gartland type 2A:
closed reduction with manipulation or
percutaneous crossed k-wire
• Gartland type 2B & 3:
closed reduction or open reduction & IF with
K-wire

17. Principles of closed reduction
• Done under general anaesthesia
• Constant longitudinal traction with elbow at
10’ flexion
• Correct sideways tilt next
• Correct rotational deformity next
• Correct antero-posterior tilt/displacement
next
• Hyperflex and Stabilize & immobilised in cast

18. Open reduction
• Indications:
- failure of closed reduction
- Open supracondylar fracture
- Associated neurovascular compromise
- Comminuted fracture
• Timing : within 5 days of injury
• Complication : ulnar injury

19. Complications
• Immediate :
 Vascular injury
 Nerve injury
• Early:
 Compartment syndrome
• Late:
 Elbow stiffness
 Volkmann’s ischemic contracture
 Myositis ossificans
 Malunion - Cubitus varus {Gunstock deformity}

20. Brauer et al: JBJS 89A,2007
• Study suggested standard crossed pins gives
5x higher probability of iatrogenic ulnar nerve
injury
• Crossed pins are more stabile & less likely to
lose reduction

21. Advances in orthopaedic surgery
volume 2016
• According to study displaced supracondylar
fractures almost always unite,but malunion was
very common in 25 to 57% cases
• So open reduction & internal fixation are better
treatment option in displaced SCH # even in
pts.who presented late after injury.this approch
minimises risk of complications & need of
corrective osteotomy
• Article id 9256540 by Dr.ram shah & Dr.raju rijal

22. JBJS 2015 by Brian p scannell & Brian k
brighton
• Prevalence of neurological injuries in pts. with
displaced SCH# is 10 to 20%
• Prevalence of vascular injuries in pts. with displaced
SCH# is 15%
• In ischemic extremity, emergent reduction & fixation is
required with reassessment of vascular status after
reduction
• In pts. with perfused pulseless extremity following SCH
# prompt reduction & fixation is required. if extremity
remains well perfused & pulse does not return,
continue observation is recommended

23. THANK YOU