SUPRACONDYLAR FRACTURE OF THE HUMERUS

 One of the most commonest & serious fractures in childhood.

 5 – 6 yrs mostly in boys

 Also called malgaigne’s #

 Often associated with complications

>Bony architecture at supracondylar region is weak

& vulnerable because in this region ;

* bone is remodeling
*less cylindrical
*cortex is very thin
*laxity of ligaments
 MECHANISM
 Fracture is caused by fall on an outstretched hand.
 Hand strikes the ground ,the elbow is forced into
hyperextension Resulting in fracture of the humerus
above the condyles.
 PATHOANATOMY
 The fracture line extends transversely through the
 distal metaphysis of the humerus just above the
condyles.
 Distal fragments – pushed backwards (coz forearm
usually pronated) and twist inwards
 Jagged end (proximal fragments) – pokes into the

soft tissue anteriorly and injure brachial artery or

median nerve
Anterior displacement (rare) – may be due to direct
violence with joint in flexion
CLASSIFICATION

 Type 1 – undisplaced
 Type 2 – angulated + posterior cortex intact

 2A : less severe - with distal fragments angulated

 2B : severe injury – fragment – angulated and malrotated
 Type 3 – completely displaced

 Type 4 – anteriorly displaced

CLINICAL FEATURES

 Following a fall ,
 Pain and swelling in elbow

 Posterior displaced fracture – S DEFORMITY

 Bony landmarks – abnormal

 Loss of both active and passive movements

 Symptoms relating to vascular or nerve injury

SIGNS
 Arm – short , forearm – normal
 Gross swelling and tenderness
 Crepitus
 S shaped deformity
 Relation between three bony point maintained (Since the
fracture is above the condyles )
 Radial and ulnar pulses may be absent with or without signs of
ischemia
 Look for an injury to the median nerve [pointing index] or the
radial nerve [wrist drop]
Soft spot – effusion beneath anconeus
 Dimple sign
due to one of
spikes of proximal
fragments
penetrate the
muscle and
tethers the skin
RADIOGRAPH
1. AP VIEW-
2. BAUMANNS TRIANGLE – angle b/w horizontal line of elbow and
line drawn through lateral epiphysis and long axis of arm
(normally less than 5 )
3. Angle b/w long axis and transverse axis of elbow normally 90
<90 – cubitus varus
>90 – cubitus valgus

Anterior humeral line – line
Tear drop sign : from anterior border pass
through middle 1/3rd of
 disturbed capitulum, if pass through
anterior 1/3rd indicates
posterior displacement
Coronoid line :line proximally
along anterior border of
coronoid of ulna should barely
touch anterior part of lateral
epicondyle – posterior disp of
lateral condyle project the
ossification center posterior to
the line
 Lateral view –
 Fat pad sign : distended capsule with effusion cause
visualization of fat pad
 Fish tail sign : due to rotation of distal fragments ,anterior border
of proximal fragments looks like sharp spike
 Crescent sign :normal radiolucent gap is missing , crescent
shape due to overlap of
capitulum over olecranon
 TREATMENT
 Undisplaced fracture-immobilization of elbow in 90degree
flexion(splint/cast) with sling, xray – 5-7 days to check displacement
, splinrt retained for 3 weeks

 Type 2A (POSTERIOR ANGULATION –MILD): reduction under GA

 Technique of closed reduction- 3 steps

1. Traction with the elbow in 30-40 degree of flexion :applied for 2

min,with an assistant giving counter traction at the arm. This step
corrects proximal displacement and medial lateral displacement
2. Flexion in traction to 120 and pronation of forearm
3. Pressure over the olecranon( to correct posterior tilt)
 If fracture unstable – fixed with percutaneous smooth k wire
 mostly either crossed k wire or two lateral wires used, backslab
is applied
 after reduction , arm held in collar and cuff (circulation
checked)
 X ray – after 3 – 5 days

 Splint retained – 3-4 weeks

FOR TYPE 2B AND 3:ANGULATED = MALROTATED OR POSTERIOR
DISPLACEMENT
 Reduction under GA then held with percutaneous smooth k wire

 OPEN REDUCTION :
FOR 1} which cannot be closely reduced
2}open fracture
3} associated vascular damage
Fracture exposed laterally , hematoma evacuated , fracture
reduced and held by two k wires
 Continous traction – through screw in olecranon
 with arm held overhead
 1) f fraction severely displaced or unable to reduce
2) sever open or multiple injuries

Anteriorly displaced fractures :

reduced by pulling forearm with elbow semi flexed apply thumb
pressure over front of distal fragments and extend elbow fully
If posterior slab – retain for 3-4weeks
DIFFERENTIAL DIAGNOSIS

 Pulled elbow
 Lateral condylar fracture