Supracondylar fracture

Q: What is the diagnosis? show answer

A: Supracondylar fracture

Q: What classification is most commonly used, and what type would this be? show answer

A: Classification is divided into three types each with a subtype (see related article on classification). It is based primarily on the degree and direction of displacement and presence of intact cortex. This would be a type IB fracture (minimally displaced, anterior humeral line still intersects part of the capitellum).

Q: What is the 'sail sign'? show answer

A: The sail sign describes the displacement of the anterior fat pad to create a shape reminiscent of a spinnaker sail on a boat. It is caused by a joint effusion and should make one suspect an occult fracture where a fracture is not demonstrated. In children, the sail sign is usually seen secondary to a supracondylar fracture.

Q: How are supracondylar fractures treated? show answer

A: Management depends on the type and degree of angulation. Type I fractures are stable and can be treated with cast immobilisation for ~3 weeks. Type II fractures require reduction and usually pinning. Type III fractures usually require open reduction and internal fixation.

Q: What are the main complications of these fractures? show answer

A: 1) malunion, resulting in cubitus varus; 2) ischaemic contracture (Volkmann contracture) due to damage / occlusion to the brachial artery; 3) damage to the ulnar nerve (most common), median nerve or radial nerve.