Supracondylar Fracture – Paediatric

Q: 7F, FALL FROM 10 FT: OBVIOUS LEFT ELBOW DEFORMITY: HOW WOULD YOU MANAGE IT?

A: ATLS protocol. Lifesaving before limb saving.

Symptoms:

Trauma/fall, pain, swelling, +- cold limb (cyanotic looking)

Signs:

Distress, swelling, +- cyanosis, thorough NV check, especially AIN and radial artery.

Imaging:

Plain Radiography

  • Check Baumanns angle (line through the ossification centre of lateral epicondyle vs perpendicular line subtending the ant humeral line)
  • Ensure radial head pointing to capitellum in all views: if not: its lat condyle fracture or Monttegia)

Classification:

Gartland 1: Minimally displaced

Gartland 2: Posteror cortex intact

Gartland 3: Complete disruption

Immediate Management:

If NV intact: Analgesia, XR AP and Lateral, backslab for comfort.

Gartland 1: Rx backslab, post slab views: Rv clinic 1 week: change to full cast: 2-3 weeks: then ROM exercise.

Garland 2: For 2 Low threshold to Rx as 3

Gartland 3: Mark and consent (main guardian for pt) – MUA + K wire.

Procedure

For an appropriately marked and consented pt:

Preplanning/templating/ Team brief/ WHO check list.

Supine, arm board. With tourniquet.

MUA: Traction (forearm/ countertraction upper arm), reduce valgus or varus deformity and concurrently apply  anterior pressure on olecronon, then hyperflex elbow. Check I/I: confirm adequate ant humeral line and radial head facing capittelum

1.6 or 1.8 mm retrograde K wires from lateral epicondyle: divergent at fracture site: distal lateral to proximal medial (bicorticol): gives enough stability, 3rd can be added medially: mini open: ensure ulnar not trapped.

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