SUPRACONDYLAR FRACURE
OF THE HUMERUS IN
CHILDREN
FARDAN MOHAMMED A
ROLL NO 21
2018 Batch
Anatomy
The elbow joint is a hinge joint
Formed between the lower end of the humerus and upper ends of the radius and
ulna.
The lower end of the humerus is enlarged to form the trochlea medially and
capitulum laterally.
Medial to the trochlea is medial epicondyle and lateral to the capitulum is the
lateral epicondyle which are continuation of the medial and lateral supracondylar
ridges respectively.
Includes two articulations:
a) humero-ulnar articulation (between the trochlea of the humerus and trochlear
notch of the ulna)
(b) humero-radial articulation (between the capitulum of the humerus and the
Three Bony Points Relationship
The three prominent bony points around the elbow
Medial epicondyle,
Lateral epicondyle
Tip of the olecranon.
In flexed elbow these three bony points form a near-
isosceles triangle
In extended elbow they lie in a straight horizontal line
Base of the triangle between the two epicondyles is the
longest arm.
Side between the medial epicondyle and olecranon tip
Carrying Angle –
When the elbow joint is fully extended and supinated, the
forearm and the arm do not lie in a straight line, but form
an angle called the carrying angle.
It disappears on flexing the elbow. The normal carrying
angle is 11° in males and 14° in females
Stability of the Elbow –
1. Pulley-shaped trochlea of humerus fits properly into
jaw-like trochlear notch of ulna.
2. Strong ulnar and radial collateral ligaments
Ossification around the elbow –
Ossification centres should not be mistaken for fractures
Appearance of ossification centres can easily be remembered by the mnemonic
CRITOE :
Capitulum – 2 years.
Radial head – 4 years.
Internal(medial) epicondyle – 6 years.
Trochlea – 8 years.
Olecranon – 10 years.
External (lateral) epicondyle – 12 year
Supracondylar fracture of the Humerus
Thisis one of the most serious fractures in childhood as it is often
associated with complications
MECHANISM :
The fracture is caused by a fall on an out-stretched hand
Hand strikes ground – elbow is forced into hyperextension resulting in
fracture of the humerus just above the condyles
Pathoanatomy
The fracture line extends transversely through the distal
metaphysis of humerus just above the condyles
Types
Depending upon displacement of distal fragment
Extension type :
More common
Distal fragment extended or tilted
backwards in relation to the proximal
fragment
Flexion type:
Distal fragment is flexed or tilted forwards
Displacements
Distal fragment are displaced in the following directions:-
1.Posterior or backward shift
2.Posterior or backward tilt
3.Proximal shift
4.Medial or lateral shift
5.Medial tilt
6.Internal rotation
Gartland Classification
Diagnosis
Presenting Complaints :
The child is brought to the hospital with a history of fall, followed by
pain, swelling, deformity and inability to move the affected elbow.
O/E:
When presented early, before significant swelling has occurred, the
following clinical signs may be observed:
Unusual posterior prominence of the point of the elbow (tip of
olecranon) because of the backward tilt of the distal fragment.
Since fracture is above the condyles, the three bony points
relationship is maintained as in a normal elbow.
When presented late, gross swelling makes it difficult to appreciate
these signs
Brachialartery injury-Interruption of blood supply to the distal
extremity
Radialand ulnar pulses may be absent with or without signs of
ischemia (6 p’s)
Injury to median nerve (pointing index)
Injury to radial nerve (wrist drop)
Radiological examination:
1. In the anteroposterior view:-
Proximal shift, medial or lateral shift,
medial tilt, rotation of the distal
fragment
2.In the lateral view:-
Proximal shift,posterior shift,
posterior tilt,
rotation of the distal fragment
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