Supracondylar # Flashcards

1
Q

Who does this affect?

A
  • Paeds often
  • Almost never seen in adults
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2
Q

MOI

A
  • FOOSH
  • Elbow in extension
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3
Q

Clinical features

A
  • Recent fall/trauma
  • Sudden onset, severe pain
  • Gross deformity
  • Swelling
  • Reduced ROM
  • Ecchymosis of anterior cubital fossa
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4
Q

Nerve damage from supracondylar #

A

Carefully examine:
* Median nerve
* Anterior interosseous nerve
* Radial nerve
* Ulnar nerve

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5
Q

Vascular damage from supracondylar # - what to look for

A

Check hands for:
* Cool temperature
* Pallor
* Delayed cap refill
* Absent pulses

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6
Q

Differentials for supracondylar #

A
  • Distal humerus or olecranon #
  • Soft tissue injury
  • Subluxation of radial head
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7
Q

Investigations for supracondylar fractures

A
  • X-ray - AP and lateral
  • CT if comminuted or intra-articular extension is suspected
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8
Q

Signs on x-ray of supracondylar fracture

A
  • Posterior fat pad sign
  • Displacement anterior humeral line - in children >5yrs this should intersect middle 1/3rd of capitulum
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9
Q

Classification of supracondylar #

A
  • Gartland classification
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10
Q

Gartland classification

A
  • Type 1 - undisplaced
  • Type 2 - displaced with intact posterior cortex
  • Type 3 - displaced in two or three planes
  • Type 4 - displaced with complete periosteal disruption - diagnosed intraoperatively
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11
Q

Management of supracondylar # - initial

A
  • If NV compromise - immediate closed reduction
  • In children, usually done in theatre and secured with K wire fixation
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12
Q

Conservative management supracondylar #

A
  • For type 1 # or minimally displaced type 2 Gartland
  • Above elbow cast in 90 degrees flexion
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13
Q

Surgical management supracondylar #

A
  • Type II, III and IV = closed reduction and percutaneous K wire fixation
  • If open # need OR and percutaneous pinning
  • Ongoing vascular compromise despite reduction need vascular surgery review
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14
Q

Complications supracondylar #

A
  • Nerve palsies - anterior interosseous nerve most common, ulnar most common post op
  • Malunion –> cubitus varus (gunstock) deformity, extended forearm deviates to midline
  • Volkmanns contracture - vascular compromise, ischaemia and necrosis of flexor muscles of forearm - wrist and held permanently flexed, claw like
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15
Q
A
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