[29] Supracondylar Fractures of the Humerus Flashcards

1
Q

Where are supracondylar fractures of the humerus common?

A

In children after FOOSH

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2
Q

What are the clinical features of a supracondylar fracture of the humerus?

A

Elbow very swollen, and held semi-flexed

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3
Q

What might the sharp edge of the proximal humerus do?

A

Injure the brachial artery, which lies anterior to it

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4
Q

What are the classifications of supracondylar humerus fractures?

A

Extension

Flexion

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5
Q

What is the more common type of supracondylar humerus fractures?

A

Extension

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6
Q

What happens in an extension supracondylar humerus fracture?

A

The distal fragment of the humerus displaces posteriorly

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7
Q

What happens in a flexion supracondylar humerus fracture?

A

The distal fragment displaces anteriorly

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8
Q

What is involved in the specific management of a supracondylar humerus fracture?

A

Ensure there is no neurovascular damage

Restore the anatomy

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9
Q

What should be done if the radial pulse is absent, or damage to the brachial artery is suspected in supracondylar humerus fractures?

A

You should urgently take to theatre for reduction, with or without on-table angiogram

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10
Q

What nerve is vulnerable in supracondylar fractures of the humerus?

A

Median nerve

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11
Q

What should be done if a supracondylar fracture of the humerus is non-displaced?

A

Flex the arm as fully as possible, and applya collar and cuff for 3 weeks

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12
Q

What acts as a sling to stabilise the fracture in a non-displaced supracondylar humerus fracture?

A

Triceps

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13
Q

What should be done if a supracondylar fracture of the humerus is displaced?

A

MUA and fixation with K wires and collar and cuff with arm flexed for 3 weeks

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14
Q

What are the specific complications of supracondylar fractures of the humerus?

A

Neurovascular injury
Compartment syndrome
Gunstock deformity

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15
Q

What neurovascular injury may occur in a supracondylar fracture of the humerus?

A

Brachial artery
Radial nerve
Median nerve, especially the anterior interosseous branch

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16
Q

What does the median nerve supply?

A

The deep forearm flexors (FPL, lateral half of FDP, and pronator quadratus)

17
Q

What is the result of the potential for a supracondylar fracture of the humerus to cause compartment syndrome?

A

Should monitor closely during the first 24hrs

18
Q

What is an early sign of compartment syndrome caused by a supracondylar fracture of the humerus?

A

Pain on passive extension of the fingers (stretches the flexor compartment)

19
Q

How can compartment syndrome be managed when caused by a supracondylar fracture of the humerus?

A

Try extension of the elbow, however surgical management may be needed

20
Q

What might result from compartment syndrome in a supracondylar fracture of the humerus?

A

Volkmann’s ischaemic contracture

21
Q

What happens in Volkmann’s ischaemic contracture?

A

Fibrosis of the flexor muscles leads to a claw hand

22
Q

What causes a gunstock deformity?

A

Valgus, varus, and rotational deformities in the coronal plane do not remodel, leading to a cubitus varus (gunstock deformity)