Supracondylar Fracture

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Supracondylar Fracture

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Objectives: General anatomy of distal Humerus What is supracondylar fracture and how it occurs Complications of Supracondylar Fracture

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Distal Humerus: Medial & lateral supracondylar ridges – the widening of the humerus Medial & lateral epicondyles – prominent extension at the end Condyles – the distal end Trochlea – medial articular surface with ulna Capitulum – lateral articular surface with radius Coronoid fossa – superior to trochlea Olecranon fossa – posterior end in humerus

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Elbow joint: Consists of 3 synovial joints Humeroradial joint – hinge joint between capitulum and the head of radius Humeroulnar joint – hinge joint between trochlea and the trochlear notch of ulna Movements of these 2 joints are the flexion and extension (~180 degrees) Radioulnar joint – pivot joint between radial head and the radial notch of the ulna. This joint is involved in the supination and pronation.

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Muscle Attachments: Biceps brachii – insertion in the radial tuberosity and the forearm fascia via bicipital aponeurosis Triceps brachii – insertion in the posterior surface of olecranon process of the ulna Brachialis – insertion in the coronoid and tuberosity of the ulna

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Nerves: Radial nerve passes anterior to the lateral epicondyle Ulnar nerve passes posterior to the medial epicondyle Median nerve passes medially to the biceps muscle along with the brachial artery. It passes anterior to it and the inserts medially in the cubital fossa

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Arteries: The brachial artery is a continuation of the axillary artery It starts from the end of the teres minor muscle and ends in the cubital fossa Accompanied with the median nerve Braches into the radial and ulnar artery under the bicipital aponeurosis

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Supracondylar fracture: A fracture that occurs in the humerus above the condyles. Most common in children Occurs when falling on an outstretched hand The hand is hyperextended Force on the distal humerus causing a fracture The distal part of the fracture is pulled posteriorly by the contracted triceps muscle. This forces the proximal part of the fracture to go anteriorly This might damage the brachial artery and the median nerve.

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Complications: Damage to the brachial artery: Tear of the artery Spasm of the artery Compression to the artery Causing Compartment syndrome Volkmann's contracture Damage to the median nerve: Compression of the nerve Hard or no ability to flex the hand and move the thumb Loss of sensation on the lateral palm and 3 ½digits

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References: Netter Anatomy Gray’s Anatomy http://www.epmonthly.com/whitecoat/2009/07/whats-the-diagnosis-4/ http://www.joint-pain-expert.net/supracondylar-fracture.html

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