Supracondylar fracture: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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ICD-10 code
S42.4. Fracture of the lower end of the humerus.
To epicondylar fractures include fractures with a fracture line passing distal to the humerus body, but without violating the intraarticular part of the condyle.
What causes epicondylar fracture?
The flexural fracture occurs when it falls on the arm bent at the elbow joint.
The extensor fracture occurs when it falls onto the arm that is bent at the elbow joint.
Symptoms of an epicondylar fracture
After the injury, pain and impaired limb function appear .
Diagnosis of supracondylar fracture
Anamnesis
In the history - the corresponding injury.
Examination and physical examination
When attempting active and passive movements, crepitation is possible, felt by the patient or by the investigator. The elbow joint is deformed, considerably pinched. The triangle and the Güter line are preserved. The sign of Marx is broken - the angle between the medial longitudinal axis of the humerus and the horizontal line connecting both epicondyles have been changed. The normal angle is 90 °.
Laboratory and instrumental research
Flexor fracture. Radiographs of the distal end of the shoulder in two projections determine the fracture. The fracture line is above the condyle slanting from below and from behind, anteriorly and upward. The central fragment is displaced posteriorly and internally, peripheral - anterior and outer. The angle between the fragments is open front and inside.
Extensor fracture. On the roentgenogram, with the same level of damage, the displacement of the fragments will be different. The peripheral fragment is displaced posteriorly and outward, the central fragment is anterior and inside. The fracture line is in front and bottom - up and back. Flexors of the forearm press the peripheral fragment to the central segment. The muscles of the shoulder move the fragments along the length.
Treatment of supracondylar fracture
Conservative treatment of epicondylar fracture
Treatment of flexor epicondylar fracture of the shoulder consists in local or general anesthesia and closed manual reposition. Produce traction along the longitudinal axis of the limb, the peripheral fragment is displaced backward and inside. The reposition is performed on the limbs that are bent at the elbow joint. After the fragments are compared, the forearm is bent at an angle of 90-100 ° and fixed with a longus on the Turner for 6-8 weeks, then the longet is made detachable and left for another 3-4 weeks.
Extensor fracture. After anesthesia perform a manual reposition. The limb is bent at the elbow joint at right angles to relax the muscles and produce traction along the longitudinal axis. Peripheral fragment is displaced anteriorly and internally. Apply a longus along the Turner to the arm bent at the elbow at an angle of 60-70 °. Produce a control radiography. The period of immobilization is the same as in the flexural fracture.
If the reposition is unsuccessful, skeletal traction is used for the elbow process on the outgoing bus within 3-4 weeks. Then impose a gypsum longite. It should be remembered that during the extension the limb should be bent at the elbow joint at an angle of 90-100 ° with a flexural fracture, at an angle of 60-70 ° with the extensor.
Instead of skeletal traction for stepwise repositioning and subsequent retention of fragments, an external fixation device can be used.
Surgical treatment of supracondylar fracture
Operative treatment of supracondylar fractures is carried out in cases when all attempts to correlate fragments have been unsuccessful. The open reposition is completed by fastening the fragments with the help of plates, bolts and other devices. Impose a plaster longure for 6 weeks, then assign removable immobilization for another 2-3 weeks.
Estimated period of incapacity for work
Work ability after conservative and operative treatment of supracondylar fractures of the shoulder is restored in 10-12 weeks.
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