Supracondylar Fracture

MANUAL MINORS

A supracondylar fracture is a fracture that occurs in the distal part of the humerus, just above the elbow condyles. It is the most common elbow fracture in children, especially between the ages of 5 and 7, typically resulting from a fall onto an outstretched arm. This fracture carries a high risk of complications, such as damage to nearby nerves and blood vessels, particularly the brachial artery and the radial, median, and ulnar nerves.

Diagnosis

Diagnosis is based on clinical evaluation of pain, swelling, and deformity in the elbow following trauma. Confirmation is achieved through anteroposterior and lateral X-rays of the elbow, showing whether the fracture is displaced or not. Supracondylar fractures are classified according to the

Gartland classification: type I (non-displaced), type II (displaced with an intact fragment), and type III (completely displaced). Assessing neurovascular integrity is crucial, as nerve and artery injuries are common.

Differential Diagnosis

Condition	Characteristics
Radial head fracture	Pain in the radial head, limited mobility, more common in adults.
Elbow dislocation	Visible deformity, loss of joint alignment.
Epicondylitis	Chronic pain without acute trauma, affecting tendons without fracture.
Olecranon fracture	Pain and deformity in the posterior elbow.
Haemarthrosis	Joint effusion following trauma, with no visible fracture on X-rays.

Emergency Management

In emergencies, initial management includes immobilising the affected arm in a splint at 20 to 40 degrees of flexion to minimise pain and movement. Analgesics and anti-inflammatory drugs are administered. It is essential to assess the radial pulse and arm perfusion due to the risk of brachial artery injury.

If vascular compromise (cold hand, no pulse) is present, urgent surgical intervention is required. Displaced fractures (types II and III) require immediate reduction, often under sedation or general anaesthesia.

Definitive Treatment

In non-displaced fractures (type I), treatment consists of immobilisation with a splint for 3 to 4 weeks, followed by rehabilitation. Displaced fractures (types II and III) generally require closed reduction with percutaneous pin fixation to stabilise the fracture. In more severe cases, open reduction may be necessary. Rehabilitation is crucial to restore elbow mobility and function.