Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS





SUPRACONDYLAR FRACTURES OF THE HUMERUS

Fracture patterns include:

:: Supracondylar
:: Intercondylar (Figure 18.16)
Figure 18.16
Figure 18.16

:: Fractures of the medial and lateral epicondyles
:: Isolated fractures of the capitellum and trochlea.

Evaluation

The patient has swelling and tenderness about the elbow and pain with attempted motion. Because deformity is often masked by swelling, confirm the type of fracture by X-ray.

Evaluate the neurological and vascular status of the arm. Arterial injuries lead to compartment syndrome (see page 18–33) in the forearm and are associated with:

:: Extreme pain
:: Decreased sensation
:: Pain with passive extension of the digits
:: Decreased pulse at the wrist
:: Pallor of the hand.

Treatment

:: Perform a closed reduction, using longitudinal traction on the extended arm, followed by flexion at the elbow with anterior pressure on the olecranon (Figures 18.17 and 18.18).
Figure 18.17
Figure 18.17

Figure 18.18
Figure 18.18

:: Monitor the pulse during the reduction. If it decreases, extend the elbow until it returns, and apply a posterior splint in this position. Check the reduction by X-ray.

If a satisfactory reduction cannot be obtained, other options include:

:: Overhead traction using an olecranon pin
:: A removable splint with early motion
:: Open surgical stabilization.

Traction and early motion are useful techniques for severely comminuted fractures and gunshot injuries.

 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
Supracondylar fractures of the humerus are complex, unstable fractures


Treat with closed reduction, followed by a cast or traction



 
In cases of incomplete reduction in adults, consider open treatment


 
Injury to nerves and arteries
leads to significant complications.