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paediatric

Pediatric Supracondylar Humerus Fracture

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 6-year-old girl is brought to the emergency department after falling from monkey bars onto her outstretched hand. She has a painful, swollen left elbow held in flexion. The elbow appears S-shaped with posterior prominence. Radial pulse is palpable but weak compared to the contralateral side. She has difficulty extending her thumb and index finger. The hand is cool but capillary refill is 3 seconds.
Lateral radiograph of the elbow demonstrating a completely displaced extension-type supracondylar humerus fracture. The anterior humeral line fails to intersect the capitellum. There is posteromedial displacement of the distal fragment with the proximal spike projecting anterolaterally. The AP view confirms complete displacement with no cortical contact. The fat pads are elevated. This is a Gartland Type III fracture requiring urgent reduction and pinning.
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Lateral radiograph of the elbow demonstrating a completely displaced extension-type supracondylar humerus fracture. The anterior humeral line fails to intersect the capitellum. There is posteromedial displacement of the distal fragment with the proximal spike projecting anterolaterally. The AP view confirms complete displacement with no cortical contact. The fat pads are elevated. This is a Gartland Type III fracture requiring urgent reduction and pinning.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the radiographic findings and classify this fracture.

Question 2 (5 marks)

What is the neurovascular assessment and which structures are at risk?

Question 3 (6 marks)

Describe the management algorithm and principles of K-wire fixation.

Question 4 (5 marks)

What are the indications for open reduction?

Question 5 (4 marks)

What complications may occur and how do you prevent them?

Question 6 (4 marks)

What is Volkmann's ischemic contracture and how is it managed?

Exam Day Cheat Sheet

Must Mention

  • •Gartland: I (undisplaced), II (hinge), III (complete)
  • •Anterior humeral line: should bisect middle 1/3 capitellum
  • •AIN injury: can't make OK sign
  • •Pink pulseless hand: reduce, monitor
  • •White pulseless hand: emergency
  • •Lateral-entry pins preferred (avoid ulnar nerve)
  • •Volkmann's: fasciotomy if suspected compartment syndrome

Common Pitfalls

  • •Missing AIN injury
  • •Ignoring vascular status
  • •Wrong Gartland type
  • •Excessive elbow flexion
  • •Not protecting ulnar nerve
  • •Missing compartment syndrome