Important arteries and nerves ( median nerve, radial nerve, brachial artery, and ulnar nerve) are located at the supracondylar area and can give rise to complications if these structures are injured. The supracondylar area undergoes remodeling at the age of 6 to 7, making this area thin and prone to fractures. The olecranon acts as a fulcrum which focuses the stress on distal humerus (supracondylar area), predisposing the distal humerus to fracture. Mechanism Įxtension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow. Such malunion can result in cubitus varus deformity. The distal humerus grows slowly post fracture (only contributes 10 to 20% of the longitudinal growth of the humerus), therefore, there is a high rate of malunion if the supracondylar fracture is not corrected appropriately. Therefore, early surgical reduction is indicated to prevent this type of complication. Swelling and vascular injury following the fracture can lead to the development of the compartment syndrome which leads to long-term complication of Volkmann's contracture (fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpophalangeal joint ).
#Closed fracture elbow skin
Ī puckered, dimple, or an ecchymosis of the skin just anterior to the distal humerus is a sign of difficult reduction because the proximal fragment may have already penetrated the brachialis muscle and the subcutaneous layer of the skin. Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus. This is because the proximal fragment will be displaced antero-laterally. Radial nerve would be injured if the distal humerus is displaced postero-medially. This is evidenced by the weakness of the hand with a weak "OK" sign on physical examination (Unable to do an "OK" sign instead a pincer grasp is performed). Anterior interosseus branch of the median nerve most often injured in postero-lateral displacement of the distal humerus as the proximal fragment is displaced antero-medially.
Doppler ultrasonography should be performed to ascertain blood flow of the affected limb if the distal pulses are not palpable. Clinical parameters such as temperature of the limb extremities (warm or cold), capillary refilling time, oxygen saturation of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of peripheral nerves (radial, median, and ulnar nerves), and any wounds which would indicate open fracture. It is important to check for viability of the affected limb post trauma. This can lead to loss of muscle function. Late onset of pain (hours after injury) could be due to muscle ischaemia (reduced oxygen supply). A child will complain of pain and swelling over the elbow immediately post trauma with loss of function of affected upper limb.
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