- Discussion:
- posterior cortex is disrupted w/ no cortical contact;
- distal fragment is displaced posteriorly and proximally (by pull of triceps);
- w/ medial displacement, the medial periosteal hinge is intact;
- w/ lateral displacement, the lateral periosteal hinge is intact;
- Physical Exam:
- the proximal fragment tip may penentrate into the brachialis muscle;
- if the brachialis is buttonholed by the distal humeral spike, then the muscle
can be milked off the spike by grasping the proximal arm and squeezing
sequentially from proximal to distal;
- avoid excessive medial squeezing (to avoid N/V injury);
- references:
- Closed Reduction and Percutaneous Pinning of Displaced Supracondylar Humerus Fractures in Children: Description of
a New Closed Reduction Technique for Fractures with Brachialis Muscle Entrapment.
CL Peters, SM Scott, and PM Stevens. J. Orthop Trauma. Vol 9, No 5. p 430-434.
- Radiographs:
- on AP view displacement may be posterolateral or posteromedial which has
implications for both the
reduction and surgical managment;
- adequacy of rotational alignment of distal fragment, is difficult to determine;
- rotation of distal fragment is best determined by CT;
- rotation of distal frag of > 10 deg results in a unacceptable varus deformity;
- Treatment:
-
reduction;
-
percutaneous pin fixation:
- displaced supracondylar frxs are reduced by closed methods & stabilized by
percutaneous pin;
- this permits clinical evaluation of carrying angle once frx is stabilized;
-
open reduction is indicated for difficult closed reduction (especially when the brachialis has
button-holed thru the brachialis);
Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation.
Management of displaced extension-type supracondylar fractures of the humerus in children [published erratum appears in J Bone Joint Surg [Am 1988 Aug;70(7):1114
Displaced fractures of the medial humeral condyle in children.
Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years.
Displaced supracondylar humeral fractures in children. A comparison of results and costs in patients treated by skeletal traction versus percutaneous pinning.
Displaced supracondylar fractures of the elbow in children.
Fowles JV, Kassab MT: J Bone Joint Surg 1974;56B:490.
Transarticular fixation for severely displaced supracondylar fractures in children.
Year Book: Transarticular Fixation for Severely Displaced Supracondylar Fractures in Children.
