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Supracondylar fracture of the humerus

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Santosh Batajoo

This document discusses supracondylar fractures of the humerus, which commonly occur in children when they fall on an outstretched hand. It describes the different types of fractures (flexion, extension), symptoms (pain, swelling, deformity), diagnosis using x-rays, and treatment options which may include closed reduction, percutaneous pinning, skeletal traction or open reduction depending on the severity of the fracture and stability. Potential complications are also outlined such as vascular injury, nerve injury, malunion or nonunion.

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Dr. Santosh Batajoo Resident (Orthopedics)
Commonest fracture in children. Uncommon after the physes have closed. Also called Malgaignes fracture. The humerus breaks just above the condyles.
The distal fragment may be displaced either posteriorly or anteriorly. Common in boys. Types- flexion & extension (90%).
Supracondylar fracture of the humerus
Fall on the outstretched hand with forearm in pronation. The distal fragment is pushed backwards and twisted inwards.
Posterior angulations or displacement suggests a hyperextension injury (common). Anterior displacement is due to direct fall on the point of elbow with joint in flexion (rare).
Type I an undisplaced fracture. Type II an angulated fracture with posterior cortex still in continuity. IIA a less severe injury with the distal fragment merely angulated. IIB a severe injury; the fragment is both angulated and malrotated. Type III a completely displaced fracture.
Supracondylar fracture of the humerus
History of fall. Pain in the elbow. Elbow is swollen and tender. S-deformity of the elbow (posterior). Bony landmarks are abnormal.
Both active and passive movements of the elbow are decreased. Assessment of the neurovascular status. Relationships between the tip of the olecranon and the epicondyle are normally aligned.
Posterior tilt and shift Proximal shift Medial tilt medial / lateral shift Internal rotation
X ray
seen clearly in lateral view. Fat pad sign in undisplaced fracture. Posteriorly displaced - fracture line runs obliquely downwards and forwards and distal fragment is tilted backwards or shifted backwards.
Anteriorly displaced fracture line runs downwards and backwards and distal fragment is tilted forwards. Anterior humeral line : On a normal lateral x-ray, a line drawn along the anterior cortex of the humerus should cross the middle of the capitulum.
Normal Baumanns angle is less than 80 degrees. Fish tail sign Crescent sign Coronoid line
Supracondylar fracture of the humerus
UNDISPLACED The elbow is immobilized at 90 degrees and neutral rotation for 3 weeks. MILD POSTERIORLY ANGULATED Reduction under anaesthesia. If the reduction is unstable, the fracture should be fixed with percutaneous K- wires. Immobilized for 3 weeks
ANGULATED AND MALROTATED OR POSTERIORLY DISPLACED Usually associated with severe swelling, often unstable, risk of neurovascular injury. Reduced under general anaesthesia and then held with percutaneous K- wires.
Supracondylar fracture of the humerus
Open reduction i. When fracture cannot be reduced closed; ii. An open fracture; iii. A fracture associated with vascular damage. iv. Interposition of the biceps
SKELETAL TRACTION with an olecranon pin i. Reduction cannot be achieved and manipulation is necessary. ii. Excessive swelling and circulatory compromise. iii. Inherently unstable fracture.
Pin fixation options : i. 2 lateral pins ii. 2 crossed pins iii. 2 lateral and 1 medial pins Contraindications i. Severe swelling ii. Open fracture iii. Irreducible fracture iv. Late diagnosis
FIXATION WITH PLATE AND SCREWS i. Cannot be reduced by closed measures ii. Wound is compound iii. Concurrent neurovascular injury iv. Concurrent forearm fracture v. If prolonged immobilization is to be avoided.
EARLY- Vascular injury- brachial artery Nerve injury- anterior interosseous n,>median n.>radial n.> ulnar n. Volkmans ischemia & compartment syndrome
LATE- Malunion- uncorrected sideways tilt and rotation may lead to varus or valgus deformity. Gun stock deformity Elbow stiffness Myositis ossificans. Tardy ulnar nerve palsy Nonunion least common
Supracondylar fracture of the humerus
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Supracondylar fracture of the humerus

  • 2. Commonest fracture in children. Uncommon after the physes have closed. Also called Malgaignes fracture. The humerus breaks just above the condyles.
  • 3. The distal fragment may be displaced either posteriorly or anteriorly. Common in boys. Types- flexion & extension (90%).
  • 5. Fall on the outstretched hand with forearm in pronation. The distal fragment is pushed backwards and twisted inwards.
  • 6. Posterior angulations or displacement suggests a hyperextension injury (common). Anterior displacement is due to direct fall on the point of elbow with joint in flexion (rare).
  • 7. Type I an undisplaced fracture. Type II an angulated fracture with posterior cortex still in continuity. IIA a less severe injury with the distal fragment merely angulated. IIB a severe injury; the fragment is both angulated and malrotated. Type III a completely displaced fracture.
  • 9. History of fall. Pain in the elbow. Elbow is swollen and tender. S-deformity of the elbow (posterior). Bony landmarks are abnormal.
  • 10. Both active and passive movements of the elbow are decreased. Assessment of the neurovascular status. Relationships between the tip of the olecranon and the epicondyle are normally aligned.
  • 11. Posterior tilt and shift Proximal shift Medial tilt medial / lateral shift Internal rotation
  • 12. X ray
  • 13. seen clearly in lateral view. Fat pad sign in undisplaced fracture. Posteriorly displaced - fracture line runs obliquely downwards and forwards and distal fragment is tilted backwards or shifted backwards.
  • 14. Anteriorly displaced fracture line runs downwards and backwards and distal fragment is tilted forwards. Anterior humeral line : On a normal lateral x-ray, a line drawn along the anterior cortex of the humerus should cross the middle of the capitulum.
  • 15. Normal Baumanns angle is less than 80 degrees. Fish tail sign Crescent sign Coronoid line
  • 17. UNDISPLACED The elbow is immobilized at 90 degrees and neutral rotation for 3 weeks. MILD POSTERIORLY ANGULATED Reduction under anaesthesia. If the reduction is unstable, the fracture should be fixed with percutaneous K- wires. Immobilized for 3 weeks
  • 18. ANGULATED AND MALROTATED OR POSTERIORLY DISPLACED Usually associated with severe swelling, often unstable, risk of neurovascular injury. Reduced under general anaesthesia and then held with percutaneous K- wires.
  • 20. Open reduction i. When fracture cannot be reduced closed; ii. An open fracture; iii. A fracture associated with vascular damage. iv. Interposition of the biceps
  • 21. SKELETAL TRACTION with an olecranon pin i. Reduction cannot be achieved and manipulation is necessary. ii. Excessive swelling and circulatory compromise. iii. Inherently unstable fracture.
  • 22. Pin fixation options : i. 2 lateral pins ii. 2 crossed pins iii. 2 lateral and 1 medial pins Contraindications i. Severe swelling ii. Open fracture iii. Irreducible fracture iv. Late diagnosis
  • 23. FIXATION WITH PLATE AND SCREWS i. Cannot be reduced by closed measures ii. Wound is compound iii. Concurrent neurovascular injury iv. Concurrent forearm fracture v. If prolonged immobilization is to be avoided.
  • 24. EARLY- Vascular injury- brachial artery Nerve injury- anterior interosseous n,>median n.>radial n.> ulnar n. Volkmans ischemia & compartment syndrome
  • 25. LATE- Malunion- uncorrected sideways tilt and rotation may lead to varus or valgus deformity. Gun stock deformity Elbow stiffness Myositis ossificans. Tardy ulnar nerve palsy Nonunion least common