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Introduction
Epidemiology
incidence
Years at ossification
(appear on xray) (1)
Capitellum
12
Radius
15
Medial epicondyle
17
Trochlea
12
Olecranon
10
15
Lateral epicondyle
12
12
Classification
Gartland Classificaiton
(may be extension or flexion type)
Type I
Type II
Type III
Completely displaced
Type IV*
Presentation
Symptoms
o pain
o refusal to move the elbow
Physical exam
o inspection
gross deformity
swelling
bruising
o motion
limited active elbow motion
o neurovascular
nerve exam
AIN neurapraxia
unable to flex the interphalangeal joint of his thumb
and the distal interphalangeal joint of his index
finger (can't make A-OK sign)
radial nerve neurapraxia
inability to extend wrist or digits may be present due
to radial nerve injury neurapraxia
vascular exam
vascular insufficiency at presentation is present in 5 -17%
defined as cold, pale, and pulseless hand
a warm, pink, pulseless hand does not qualify
as vascular insufficiency
treat with immediate reduction and pinning in OR.
Attempted closed reduction in ER first (see treatment
below)
Imaging
Radiographs
o recommended views
o findings
o measurement
Treatment
Nonoperative
o long arm posterior splint then long arm casting with less
than 90 of elbow flexion
indications
indications
technique
check vascular status after reduction
explore if pulse lost after reduction or if pulseless,
pale hand persists after reduction
arteriography is typically not indicated
Techniques
usually sufficient
Complications
Pin migration
o most common complication (~2%)
Infection
o occurs in 1-2.4%
o typically superficial and treated with oral antibiotics
Cubitus valgus
o caused by fracture malunion
o can lead to tardy ulnar nerve palsy
Cubitus varus (gunstock deformity)
o caused by fracture malunion
o usually a cosmetic issue with little functional limitations
Recurvatum
o common with non-operative treatement of Type II and Type III
fractures
Nerve palsy
o usually resolve
Vascular Injury
Volkmann ischemic contracture
o rare, but dreaded complication associated with supracondylar
humerus fractures
o more often as a result of brachial artery compression with
treatment utilizing elbow hyperflexion and casting than true
arterial injury
increase in forearm compartment pressures and loss of