4. Primary survey
• A : can talk, no limit ROM of the neck, not tender along c-spine
• B : trachea in midline, normal chest movement, normal and equal
breath sounds both lungs, CCT negative
• C : BP 96/60 mmHg, PR 100 bpm, RR 24 /min, BT 36.8 C, PCT negative
• D : E4V5M6, pupil 3mm RTLBE
• E : left elbow marked swelling with deformities, no external bleeding,
no LW,ecchymosis, limit ROM, brachial ulnar and radial pulse 2+ , cap
refill 2 sec
5. Secondary survey
• A : no food/drug allergy
• M : no current medication
• P : no underlying disease , no surgical history
• L : last meal 6 hr PTA
• E : แขนซ้ายฟาดขอบเตียงสูงประมาณ 60 เซนติเมตร
6. Physical examination
• V/S : BT 36.8 C , BP96/60 mmHg , RR 24/min , PR 100 bpm
• GA: A Thai girl , good consciousness , well cooperative
• HEENT : not pale conjunctivae , anicteric sclerae
• Heart : normal S1S2 , no murmur
• Lung : normal and equal breath sound both lungs
• Abdomen : soft , not tender , no guarding , not distention
• Neuro : grossly intact sensory , motor grade v all
7. Physical examination
• Extremity :
• Left elbow marked swelling limit ROM due to pain
• Deformity left arm
• Brachial ulnar and radial pulse 2+
• Sensory intact
• Capillary refill <2sec
• Median radial and ulnar nerve intact
12. Supracondylar fracture
• Most common fracture around elbow usually occur in child age 5-7
years old
• Incidence
• - extension type most common > 95 % the distal part of fracture
displace posteriorly
• - flexion type less common<5% the distal part of fracture displace
anteriorly
• Mechanism of injury : fall on outstretched hand
13. Baumann’s angle 64-
82 degree in AP view
Comparison to contralateral side if deviate
more than > 5 degree indicates deformity
24. Physical examination
• Gross deformity, swelling, bruising, limited active elbow motion
• Neurovascular exam – AIN , median nerve , radial nerve
• Vascular insufficiency : cold, pale and pulseless , treat with immediate
reduction and pinning in OR , attempted closed reduction in ER first
• Median nerve , ulnar nerve , brachial artery are at risk
25.
26. Radiographs
• AP and lateral x-ray of the elbow
• Findings
• - posterior fat pad sign : lucency along the posterior distal humerus
and olecranon
• - displacement of the anterior humeral line
• - Baumann’s angle +-
27. Treatment
• Gartland type l : posterior long arm slab 70-80 degree for 2-3 weeks
• Gartland type ll : closed reduction and posterior long arm slab at least
90 degree flexion for 3-4 weeks
• Gartland type lll : closed reduction under general anesthesia and fix
with K –Wire (percutaneous pinning) and posterior long arm slab for 4
weeks
29. Post-op Complication
• Compartment syndrome especially in grade lll and after reduction with
flexion
• Cubitus varus : caused by fracture varus malunion pattern with little
functional limitations
• Cubitus valgus : caused by fracture malunion
• Nerve palsy from injury(median,ulnar,radial nerve)
• Vascular injury(radial and ulnar pulse) + capillary refill
• Postoperative stiffness
• Should elevate the arm for minimize swelling
• Pressure sore
31. References
• The journal of hand surgery 2013
• The orthopaedic clinics of North America 2008
• The journal of bone and joint surgery American volume 2008
• www.orthobullets.com