The Gartland classification system of supracondylar fractures is a system commonly used in clinical practice, also aiding in management planning: Figure 2 - Plain film radiograph of a supracondylar fracture in lateral view Gartland Classification Displacement of the anterior humeral line (in children >5yrs, this should intersect the middle third of the capitellum)ĬT imaging may be useful for comminuted fractures or where intra-articular extension is suspected, which aides with surgical planning.Posterior fat pad sign (lucency visible on the lateral view).Subtle signs on plain film radiograph for a supracondylar fracture include: The mainstay of investigation for suspected supracondylar fractures is via plain film radiographs in both antero-posterior (AP) and lateral views of the elbow. Other differentials include soft tissue injury or a subluxation of the radial head. Differential Diagnosisĭistal humeral fractures and olecranon fractures are important fractures to exclude, as management of these can vary significantly. Urgent orthopaedic review is required for all supracondylar fractures, especially those with neurovascular compromise or evidence of an open fracture. It is essential to carefully examine the median nerve, the anterior interosseous nerve (the deep motor branch of the median nerve), the radial nerve, and the ulnar nerve.Ĭheck the hand for features of vascular compromise, such as a cool temperature, pallor, delayed capillary refill time, or absent pulses. Ensure to look closely for evidence of an open injury. On examination, there may be signs of gross deformity, swelling, limited range of elbow movement (secondary to pain), and ecchymosis of the anterior cubital fossa. Patients typically present following a recent fall or direct trauma, resulting in sudden-onset severe pain and reluctance to move the affected arm. Figure 1 – Bony landmarks of the distal humerus Clinical Features
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