I. Definition
Supracondylar fracture of the humerus mainly refers to fractures within 2 cm above and below the inner and outer humeral condyles, mostly seen in children aged 3-12 years, with the extensor type predominating, accounting for about 90%. This fracture can be combined with nerve and blood vessel injury, and improper treatment can cause Volkmann’s ischemic muscle contracture, elbow inversion deformity and ossifying myositis.
Diagnostic basis
Clinical manifestations.
The child has a history of trauma, and the elbow joint is locally immobile and swollen significantly after the injury. The presence of bony triangular relationship of the elbow indicates that it is not dislocated. The elbow is in a semi-flexed position and the elbow fossa is full. Sometimes the fractured end of the humerus can be palpated in the elbow fossa. If careful examination cannot be done due to heavy swelling and pain, X-ray frontal and lateral views should be taken quickly to determine the fracture and displacement. Local swelling, subcutaneous ecchymosis, deformity, pressure pain, paradoxical activity, and positive bone rub sounds may be seen at the injury site. The affected limb is functionally limited. The presence of ulnar nerve, radial nerve, median nerve, blood vessels, attention to the surrounding soft tissue injury, the presence of fascial intercompartmental syndrome may require distal blood flow, sensory and motor examination.
Imaging examinations.
The auxiliary examination method of this disease is mainly X-ray examination: when using X-ray examination on patients, in addition to frontal and lateral radiographs, special postural phases should be taken according to the injury, and body layer film or CT examination should also be performed as appropriate.
Differential diagnosis
Supracondylar fracture of humerus should be distinguished from elbow joint dislocation.
IV. Treatment
The treatment of this disease is based on different conditions.
1. External fixation in closed reduction plaster
According to the 2012 AAOS guidelines for the management of pediatric supracondylar humerus fractures, Gartland I fractures can be repositioned by manipulation under brachial plexus or general anesthesia, and fixed in a long-arm cast at 90° of flexion for 4-6 weeks.
2.Surgical treatment
For Gartland type II and III fractures, closed reduction percutaneous internal fixation with internal and external condylar crossed kerf pins is performed. After successful reduction, the child’s elbow joint should have a normal shape and can be flexed and extended normally; after successful reduction, the child’s fingers should be able to reach the shoulder.
Imaging verification of the reset effect.
(1) The longitudinal axis of the anterior humeral cortical edge passes through the humeral tuberosity.
(2) Baumann’s angle is greater than 10°.
For the following 3 cases, incisional internal fixation was performed.
(1) Failed repeated manipulation or failed closed reduction due to soft tissue embedded between the fracture ends.
2. instability of the fracture after reduction or difficulty in maintaining the stability of the fracture alignment with simple external fixation.
3, with obvious vascular and nerve injury.
After the surgery, the steel pin can be removed after 4-6 weeks when the fracture line is blurred or disappeared by radiography, and the plaster cast can be removed for functional elbow exercises.