4Īnalysis of distal fragment displacement and posterior periosteum integrity is essential. This is the mechanism of extension-type fractures, which represent 97% to 99% of the total. If the energy is high, the posterior cortex disrupts, and finally complete posterior displacement of the distal fragment occurs with the posterior periosteum acting as a hinge. Therefore, the bone begins to break at first anteriorly and the fracture progresses posteriorly. When a fall on the outstretched hand occurs, the olecranon engages on the olecranon fossa and if elbow extension progresses, the olecranon finally acts as a fulcrum on the fossa. The distal humerus anatomy is especially predisposed to injury because its configuration in two columns connected by thin bone represents a zone of weakness. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Ĭite this article: EFORT Open Rev 2018 3:526-540. Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. In most cases, fracture reduction restores perfusion. Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.Ībout 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction. Type IV fractures can only be diagnosed intra-operatively.Ĭlosed reduction and percutaneous pinning is the gold standard surgical treatment. Surgical treatment is the standard for almost all displaced fractures. Gartland’s classification shows high intra- and inter-observer reliability. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present. To manage the vascular status, distal pulse and hand perfusion should be monitored. Flexion-type fractures are more commonly associated with ulnar nerve injuries.Ĭoncomitant upper-limb fractures should always be excluded. Posteromedial displacement of the distal fragment is the most frequent however, the radial and median nerves are equally affected. Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years.Įxtension-type fractures represent 97% to 99% of cases.
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