Supracondylar Fracture of Humerus

INTRODUCTION:

This is one of the most serious fracture in childhood often associated with complications. fracture of distal humerus usually involves the supracondylar portion of humerus and are extra-articular. Basically, a supracondylar fracture of the humerus is a broken elbow. But it refers to a specific portion of the elbow. In this type of fracture, the humerus bone is involved.

MECHANISM:

The fracture is caused by fall on an outstretched hand. As the hand strikes the ground the elbow is forced into hyperextension resulting in fracture of humerus above the condyles.

PATHO-ANATOMY:

The fracture line runs transversely through the distal metaphysic of humerus just above the condyles.

TYPES: depending on displacement of distal fragments.

FLEXION TYPE: the distal fragment is flexed(tilted forwards)in relation to proximal fragment.

EXTENSION TYPE: is more common here the distal fragment is extended(tilted  backwards) in relation to proximal fragment.

DISPLACEMENT:

Commonly the supracondylar fracture is displaced. the distal fragments may be displaced in following directions.:

  • Posterior or backward shift
  • Posterior or backward tilt
  • Proximal shift
  • Medial or lateral shift
  • Medial tilt
  • Internal rotation

DIAGNOSIS:

PRESENTING COMPLAINTS: history of fall followed by pain, swelling , deformity and inability to move the affected elbow.

EXAMINATION: when presented early before significant swelling has occurred the following clinical signs may be observed:

  • Unusual posterior prominence of the point of elbow (tip of olecranon) because of backward tilt of distal fragment.
  • Since the fracture is above the condyles the three bony relationship is maintained as in the normal elbow.

When presented late gross swelling makes it difficult to appreciate these signs, thus making clinical diagnosis difficult.:

  • The possibility of interruption of blood supply of distal extremity because of an associated brachial artery injury.
  • radial and ulnar pulse may be absent with or without signs of ischaemia.
  • Pointing index finger due to injury to median nerve
  • Wrist drop due to radial nerve injury.

RADIOLOGY: easy to diagnose the fracture because of wide displacement following displacement are seen on X-RAY:

In an anterior posterior view one can see the:

  • Proximal shift
  • Medial or lateral shift
  • Medial tilt
  • Rotation of distal fragment

In lateral view:

  • Proximal shift
  • Posterior shift
  • Posterior tilt
  • Rotation of the distal fragment

TREATMENT:

Undisplaced fractures require immobilization in an above elbow plaster slab,with the elbow in 90 degrees flexion.In all displaced fractures,the person should be admitted to a hospital because serious complications can occur within the the first 48 hours.

The following methods are used in displaced fractures.

  • Closed reduction and per-cutaneous K-wire fixation:

Technique of closed reduction:It is carried out in the following steps

  • Traction with the elbow in 30-40 degrees of flexion :Traction is applied for 2 mins,with an assistant giving counter-traction at the arm.While in traction,the elbow is gradually extended and the forearm fully supinated.this manoeuvre corrects proximal displacement and medial-lateral displacements.If required,the “carrying angle”of the elbow is corrected at this stage.
  • Flexion in traction:With one hand maintaining traction,the upper arm is grasped with the other hand,placing the fingers over the biceps so that the thumb rests on the olecranon.The elbow is now flexed slowly,using the hand with which traction is being applied,so as to flex the elbow while continuous traction is maintained in the long axis of the forearm.
  • Pressure over the olecranon:While the above manoeuvre is continued,the thumb over the olecranon presses the olecranon(and with it the distal fragment)forward into flexion.Traction is maintained as the elbow is flexed to beyond 90 degrees
  • Open reduction and K-wire fixation:

In some cases,it is not possible to achieve a good position by closed methods,or the fracture gets redisplaced after reduction.In such cases,open reduction and K-wire fixation is necessary.This is also used as a first line of treatment in some open fractures and in those requiring exploration of the brachial artery for suspected injury.

  • Continuous traction:This is required in cases presenting late with excessive swelling or bad wounds around the elbow.The traction may be given with a K-wire passed through the olecranon(Smith’s traction)or a below-elbow skin traction(Dunlop’s traction).

COMPLICATIONS:

IMMEDIATE COMPLICATIONS:

  • Injury to brachial artery
  • Injury to radial nerve
  • Injury to median nerve

EARLY COMPLICATIONS:

  • Volkmann’s ischaemia

LATE COMPLICATIONS:

  • Malunion
  • Myositis  ossificans
  • Volkmann’s ischaemic contracture

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relief pain
  • Restoring range of motion
  • Strengthening of muscles
  • Prevention of complications

Visit Physioline for the Consultation and treatment