Supracondylar Final

8/3/2019 Supracondylar Final

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Supracondylarfractureis a fracture of the lower end of the humerus bone just above the elbow

joint. It is a very common fracture in children and rare in adults. It is caused by a fall on the out

stretched hand with a hyper-extension force acting on the elbow.

This fracture is

most common between the age of 5 to 9 years

two times more common in males

right to left side ratio is 2:3

Classification is into three types depending in the degree of separation of fracture fragments.

Type 1 are undisplaced or minimally displaced fractures (fracture is hairline) bones

aligned and no deformity.

Type 2 are partially displaced (fragments are nearly aligned, some bony contact is

present) bones fragment moved partially - minor deformity

Type 3 are completely displaced (fracture fragments are far apart from each other)

bones fragment completely separated - major deformity

Signs and Symptoms:

Pain and bruising.

Swelling , especially in type 2 and 3 injuries.

Tenderness (pain when touched).

Trouble moving your arm. You may not be able to move your arm at all.

Weakness or numbness (loss of feeling),tingling or cold, pale skin in your elbow, arm, or

hand.

Deformity (your arm is shaped differently than normal) in type 2 and 3 injuries.

In type 1 injuries, it may not be clear that there is a fracture present due to mild swelling

and pain. Watch out for a child guarding and not using the elbow.

Patho-anatomy

The fracture lines extend transversely through the distal end [metaphysis] above the condyles.
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Diagnosis:

X ray of the elbow joint. X ray will show the fracture and will help in classification.

Computed tomography scan: This test is also called a CT scan. This is a type of x-ray that

uses a computer to take pictures of your elbow joint and arm. You may be given a dye before

the pictures are taken to help caregivers see the pictures better. People who are allergic to

iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if

you are allergic to shellfish or have any other allergies.

Magnetic resonance imaging: This test is also called an MRI. Magnetic waves are used to

take pictures of your elbow joint and arm. You will need to lie still during an MRI. Neverenter

an MRI room with any metal objects. This can cause serious injury.

Treatment of supracondylar fracture is based on the classification:

Type 1 fractures are treated with simple immobilization in a plaster cast without any

manipulation.

Type 2 fractures are treated by manipulation followed by immobilization in a plaster

cast. The cast is kept for three weeks. Type 3 fractures require operative treatment. An attempt is made to reduce the fracture

without exposing the bone fragments through an incision. If successful then the fracture

is held in place by 1.5 or 2mm stainless steel wires called K wires.

If this is unsuccessful then the fracture is exposed by a incision and the bone fragments

are aligned under vision. They are then held in place by K wires.

The goal of treatment is to regain the function of your elbow. Treatment may help

decrease your symptoms and help you return to your daily activities. You may need any

of the following:

Devices: A brace, cast, sling, or splint may be put on your elbow to decrease your

arm movement. These devices work to hold the broken bones in place. They may help

decrease pain, and prevent more damage to your broken bones.


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Medicines:

Pain medicine: You may be given medicine to take away or decrease pain. Do not

wait until the pain is severe before you take your medicine.

Nonsteroidal anti-inflammatory medicine: This group of medicine is also called

NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and swelling. This

medicine can be bought without a doctor's order.

Antibiotics: This medicine will help fight or prevent an infection. Take your antibiotics

until they are gone, even if you feel better.

Tetanus shot: You may need a tetanus shot if you have breaks in your skin from

your injury. A tetanus shot is medicine to prevent you from getting tetanus. Tetanus is aserious infection that can happen after any break in your skin. The shot is normally given into

your arm. You should have a tetanus shot if you have not had one in the past 5 to 10 years.

Your arm can get red, swollen, and sore after this shot.

Surgery:

If you have an open fracture, you may need debridement before your surgery.

Debridement is when damaged and infected tissue is removed and the wound is cleaned.

Debridement is done to help prevent infection and improve healing.

Arthroplasty: This surgery is done to remove the damaged part of your elbow and

replace it with an implant. An implant is a metal, ceramic, or plastic device that functions

like your elbow joint. Your whole elbow joint, or only a part of it may be replaced.

Fragment excision: The broken fragments (pieces) of bone are removed from

your elbow during this surgery.

Open reduction and internal fixation: An incision (cut) will be made in your arm.

Your broken bones will be straightened. Wires, screws, metal plates, or pins may be used

to hold your broken bones together. This surgery will allow your broken bones to grow

back together.


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Bone graft: A bone graft replaces lost bone from your fracture. A bone graft is a

piece of bone taken from another area of your body. The bone graft may also be from a

donor (another person). The graft is put into spaces between or around the broken bones

in your elbow. This surgery may help your bones heal and keep their strength.

Electrical stimulation: Electric currents are directed into your injured elbow. The

currents increase the blood flow to your elbow to help with healing. This treatment may be

used along with other treatments for your elbow fracture.

Ultrasound therapy: Ultrasound treatments use sound waves directed into your

elbow. The sound waves work by helping the bones in your elbow heal. You may need this

treatment along with other treatments.

Nursing Care:

Elevate the elbow: Use pillows to keep the elbow raised above the level of your

heart as often as you can. This helps decrease swelling and pain, and improves blood

flow. While the elbow is elevated, wiggle your fingers and open and close them to prevent

hand stiffness.

Ice: Use ice to help decrease swelling and pain. Put crushed ice in a plastic bag and

cover it with a towel. Put the ice pack on your elbow for 15 to 20 minutes every hour. Use

the ice for as long as directed.

Physical therapy: You may need physical therapy. A physical therapist will help you

with exercises to improve the movement of your elbow joint and arm. The exercises can

also help make your arm bones and muscles stronger.


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Supracondylar Final