Supracondylar Humerus Fractures

Because Supracondylar Humerus Fractures are rotationally unstable and have a high rate of neurovascular complications, they should be considered an orthopedic emergency. For those fractures that are displaced, unstable or cannot be reduced without jeopardizing the blood supply, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic) followed by surgical external or internal fixation to stabilize the fracture (e.g. using pins). This may be followed by the use of a splint, plaster cast, sling or brace for a number of weeks.

For those isolated Supracondylar Humerus Fractures that are not displaced treatment typically involves immobilization either via external or internal fixation, a splint or plaster cast for approximately 4 – 6 weeks.

The orthopedic surgeon will determine the most suitable treatment for the fracture based on a number of factors such as the location, type and severity of the fracture.

Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can generally begin as guided by the treating physiotherapist.

One of the most important components of rehabilitation following a Supracondylar Humerus Fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the humerus should also be avoided particularly lifting, weight bearing or pushing activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the fracture altogether.

Patients with a Supracondylar Humerus Fracture should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with immobilization. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Supracondylar Humerus Fractures

Supracondylar Humerus Fractures

Patients with a Supracondylar Humerus Fractures typically experience a sudden onset of sharp, intense elbow or upper arm pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the injury. Pain can occasionally settle quickly leaving patients with an ache at the site of injury that is particularly prominent at night or first thing in the morning. Patients with this condition may also experience swelling, bruising and pain on firmly touching the affected region of the bone. Pain may also increase during certain movements of the elbow, wrist or shoulder or during weight-bearing activity (such as pushing) through the affected arm. Pins and needles or numbness may also be present in the elbow, forearm, hand or fingers. In severe Supracondylar Humerus Fractures (with bony displacement), an obvious deformity may be detected.

Diagnosis

A thorough subjective and objective examination from a physiotherapist or doctor is essential to assist with diagnosis of a Supracondylar Humerus Fractures. An X-ray is required to confirm diagnosis. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of injury.

Supracondylar Humerus Fractures

Supracondylar Humerus Fractures

A Supracondylar Humerus Fractures is a condition characterized by a break in the upper arm bone just above the elbow joint. This type of sickness in adults are relatively uncommon injuries, representing only approximately 3% of all fractures in adults. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious complications.

There is the elbow joint comprises the union of 3 long bones which are the humerus (upper arm bone), the ulna and the radius (lower arm bones). The humerus has two bony prominences known as the epicondyles situated at the inner and outer aspect of the elbow. Just above the epicondyles is a region of the humerus bone known as the supracondylar region.

We live in a society with a growing elderly population and a young population in which extreme sports and high-speed motor transportation are popular; therefore, the incidence of these fractures is likely to increase. In young adults, most distal humerus fractures occur from high-energy trauma, sideswipe injuries, motor vehicle accidents, falls from heights, and gunshot wounds. In elderly persons with more osteoporotic bone, most of these injuries occur from falls.

It may be of a flexion type or an extension type, depending upon the displacement of the distal fragment of bone.

Extension type: The most common type, accounting for 80% of all  Supracondylar Humerus Fractures. The distal fragment is displaced posteriorly. Flexion type: The least common variety is the distal fragment displacing anteriorly relative to the proximal segment.

Displacements: The displacements may present in one of a number of ways: posterior shift, posterior tilt, lateral or medial shift, proximal shift or internal rotation.

There are three types based on the degree of separation of the fractured fragments.

• Type I: undisplaced or minimally displaced fractures.
• Type II: partially displaced and
• type III: fully displaced.

Supracondylar Humerus Fractures can vary in location, severity and type including, displaced fracture, un-displaced fracture, greenstick, comminuted etc.