Supracondylar fracture
Encyclopedia
A supracondylar fracture is a fracture, usually of the distal humerus
just above the epicondyles, although it may occur elsewhere. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious complications.
Extension type:
The most common type, accounting for 80% of all supracondylar fractures. The distal fragment is displaced posteriorly.
Flexion type:
The least common variety is the distal fragment displacing anteriorly relative to the proximal segment.
Displacements:
The displacements may present in one of a number of ways: posterior shift, posterior tilt, lateral or medial shift, proximal shift or internal rotation.
The child presents with history of a falling on an outstretched hand followed by pain, swelling and inability to move the affected elbow.
On examination:
Unusual prominence of olecranon process but because it is a supracondylar fracture, the three bony point relationship is maintained, as in a normal elbow.
; (b) spasm of the artery and (c) compression of the artery relieved by manipulation of the fracture (d) compression of median nerve.
Causing Pink and Pulseless hand in supra condylar fracture.
Thus there is loss of circulation of forearm, causing lack of reperfusion of tissues resulting in tissue death causing compartment syndrome
.
(See Volkmann Contracture)
Therefore the complications of elbow dislocations include the following:
(permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers).
. The fracture can however be difficult to identify and often a joint effusion is used to increase one's suspicion of the presence of a fracture. The existence of an effusion can be determined by the presence of the sail sign
.
Humerus
The humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow....
just above the epicondyles, although it may occur elsewhere. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious complications.
Classification
It may be of a flexion type or an extension type, depending upon the displacement of the distal fragment of bone.Extension type:
The most common type, accounting for 80% of all supracondylar fractures. The distal fragment is displaced posteriorly.
Flexion type:
The least common variety is the distal fragment displacing anteriorly relative to the proximal segment.
Displacements:
The displacements may present in one of a number of ways: posterior shift, posterior tilt, lateral or medial shift, proximal shift or internal rotation.
Presentation
Presenting complaints:The child presents with history of a falling on an outstretched hand followed by pain, swelling and inability to move the affected elbow.
On examination:
Unusual prominence of olecranon process but because it is a supracondylar fracture, the three bony point relationship is maintained, as in a normal elbow.
Neurovascular complications
(a) tear or entrapment of the brachial arteryBrachial artery
The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...
; (b) spasm of the artery and (c) compression of the artery relieved by manipulation of the fracture (d) compression of median nerve.
Causing Pink and Pulseless hand in supra condylar fracture.
Thus there is loss of circulation of forearm, causing lack of reperfusion of tissues resulting in tissue death causing compartment syndrome
Compartment syndrome
Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...
.
(See Volkmann Contracture)
Therefore the complications of elbow dislocations include the following:
- Posttraumatic periarticular calcification, which occurs in 3-5% of elbow injuries
- Myositis ossificansMyositis ossificansMyositis ossificans comprises two syndromes characterized by heterotopic ossification of muscle.-Classification:* In the first, and by far most common type, nonhereditary myositis ossificans , calcifications occur at the site of injured muscle, most commonly in the arms or...
or calcific tendinitisCalcific tendinitisCalcific tendinitis , a form of tendinitis, is a disorder characterized by deposits of hydroxyapatite in any tendon of the... - Neurovascular injuries (8-21% of cases) — palsy to the anterior interosseus nerve at time of index injury is most common, followed by brachial artery injuries (5-13%). Injury to the ulnar nerve is reported with percutaneous pinning through the medial epicondyle.
- Osteochondral defects, intra-articular loose bodies, and avascular necrosisAvascular necrosisAvascular necrosis is a disease where there is cellular death of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses...
of the capitellum - Instability
Secondary injury
Most commonly brachial artery injury, and if left untreated could lead to Volkmann's contractureVolkmann's contracture
Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers. It is more common in children. Passive extension of fingers is restricted and painful...
(permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers).
Mechanism
The fracture is caused by fall on an outstretched hand in 70% of cases. As the hands hits the ground, the elbow is hyperextended resulting in fracture above the condyles. This fracture is most commonly seen in children between the ages of 5-15 yrs. It is a very important clinical condition where medical attention is necessary.Patho-anatomy
The fracture lines extend transversely through the distal end [metaphysis] above the condyles.Diagnosis
Diagnosis is usually by X-rayX-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
. The fracture can however be difficult to identify and often a joint effusion is used to increase one's suspicion of the presence of a fracture. The existence of an effusion can be determined by the presence of the sail sign
Sail sign
On an elbow X-ray the sail sign suggests an occult fracture. Its name derives from the fact that, with some imagination, it has the shape of a spinnaker . It rises from displacement of the fat pad around the elbow joint...
.