SUPRACONDYLAR FRACTURES OF THE HUMERUS

Fracture patterns include:

::	Supracondylar
::	Intercondylar (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:

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 18.18
::	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:

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