Extraarticular Metaphyseal Fracture | Extension vs Flexion Type | High Stiffness Rate
AO/OTA 13-A CLASSIFICATION
Critical Must-Knows
- Extraarticular by definition - articular involvement = intercondylar fracture
- Extension type (95%) - distal fragment displaces posteriorly
- Flexion type (5%) - distal fragment displaces anteriorly
- Adults differ from children - osteoporotic bone, stiffness is major issue
- Dual column fixation preferred even for extraarticular fractures
Clinical Pearls
- "Draw the distinction from pediatric supracondylar fractures clearly
- "Examiners expect discussion of extension vs flexion type
- "Know the surgical approaches - posterior vs lateral vs medial
- "Discuss stiffness prophylaxis and early ROM protocols
Clinical Imaging
Imaging Gallery
Exam Warning
Adult supracondylar fractures are EXTRAARTICULAR by definition. If there is articular involvement, it is an intercondylar fracture (AO 13-C). Examiners will test this distinction. Extension type (95%) has posterior displacement of the distal fragment - do not confuse with the mechanism!
At a Glance
Adult supracondylar humerus fractures are extraarticular metaphyseal fractures representing 10% of distal humerus fractures. Unlike pediatric supracondylar fractures (which occur in 5-7 year olds via FOOSH), adult fractures occur in osteoporotic bone (peak 50-60 years) via axial loading. Extension type (95%) shows posterior displacement of the distal fragment. The major concern is stiffness (up to 50% functional ROM loss), not deformity as in children. Treatment requires dual column plating for stable fixation allowing early ROM. Know the AO 13-A classification: A1 (simple), A2 (wedge), A3 (complex metaphyseal). Articular involvement reclassifies as intercondylar fracture (13-C).
Adult vs Pediatric Supracondylar Fractures
| Feature | Adult | Pediatric |
|---|
Mnemonics
EXTENDExtension Type Features
| E | Extension mechanism Fall onto outstretched hand with elbow extended |
| X | X-ray shows posterior displacement Distal fragment displaces posteriorly |
| T | Tension side anterior Anterior cortex in tension, posterior in compression |
| E | Ecchymosis anterior Soft tissue bruising anteriorly |
| N | Ninety-five percent 95% of supracondylar fractures are extension type |
| D | Deformity S-shaped Classic S-shaped deformity on lateral view |
| E | Extension mechanism Fall onto outstretched hand with elbow extended | T | Tension side anterior Anterior cortex in tension, posterior in compression | N | Ninety-five percent 95% of supracondylar fractures are extension type |
| X | X-ray shows posterior displacement Distal fragment displaces posteriorly | E | Ecchymosis anterior Soft tissue bruising anteriorly | D | Deformity S-shaped Classic S-shaped deformity on lateral view |
Hook:EXTEND reminds you of the mechanism and that this is the common (95%) type with posterior displacement
STIFFComplications in Adult Supracondylar Fractures
| S | Stiffness Most common complication - up to 50% functional ROM loss |
| T | Triceps weakness From approach or scarring |
| I | Infection Higher with extensile approaches |
| F | Fixation failure Especially in osteoporotic bone |
| F | Fracture nonunion More common than pediatric |
| S | Stiffness Most common complication - up to 50% functional ROM loss | F | Fixation failure Especially in osteoporotic bone |
| T | Triceps weakness From approach or scarring | F | Fracture nonunion More common than pediatric |
| I | Infection Higher with extensile approaches |
Hook:Adult elbows get STIFF - this is the main concern, not deformity like in children
PLATESDual Plating Principles
| P | Perpendicular or parallel Both configurations acceptable per AO |
| L | Long plates preferred At least 6 cortices proximal to fracture |
| A | Articular reduction first Even though extraarticular, restore anatomy |
| T | Two columns stabilized Medial and lateral columns independently fixed |
| E | Early ROM protocol Stable fixation allows early mobilization |
| S | Screw density important Maximum screw purchase in distal fragments |
| P | Perpendicular or parallel Both configurations acceptable per AO | A | Articular reduction first Even though extraarticular, restore anatomy | E | Early ROM protocol Stable fixation allows early mobilization |
| L | Long plates preferred At least 6 cortices proximal to fracture | T | Two columns stabilized Medial and lateral columns independently fixed | S | Screw density important Maximum screw purchase in distal fragments |
Hook:PLATES reminds you of the dual plating technique for stable fixation allowing early ROM
Overview and Epidemiology
Adult supracondylar humerus fractures are extraarticular fractures occurring in the metaphyseal region of the distal humerus, proximal to the condyles. They represent approximately 10% of all distal humerus fractures in adults.
Key Distinguishing Features
- Extraarticular by definition - any articular involvement classifies as intercondylar (13-C)
- Metaphyseal location - between the supracondylar ridges and olecranon fossa
- Different from pediatric - mechanism, bone quality, and outcomes differ significantly
Epidemiology
| Factor | Adult Pattern | Pediatric Comparison |
|---|---|---|
| Peak Age | 50-60 years (osteoporotic) | 5-7 years |
| Gender | Female predominant (2:1) | Male predominant |
| Mechanism | Axial load, direct trauma | FOOSH hyperextension |
| Associated Injuries | Wrist fractures, other fragility | Isolated injury typical |
Bimodal Distribution
- Young adults (20-40): High-energy trauma (MVA, falls from height)
- Elderly (50+): Low-energy falls on osteoporotic bone
Differential Diagnosis
The key differential is distinguishing a true extra-articular supracondylar fracture from intra-articular and adjacent injuries, because this changes classification, approach and prognosis.
Differential Diagnosis of the Painful, Swollen Adult Elbow After Trauma
| Diagnosis | Distinguishing Feature | Key Investigation |
|---|
Anatomy and Biomechanics
Dual Column Concept
The distal humerus consists of two columns forming a triangular architecture:
Medial Column
- Extends from supracondylar ridge to medial epicondyle
- Contains the trochlea (articulates with ulna)
- Common flexor origin attachment
- Ulnar nerve courses posteriorly
Lateral Column
- Extends from supracondylar ridge to lateral epicondyle
- Contains the capitellum (articulates with radius)
- Common extensor origin attachment
- More robust than medial column
Supracondylar Region
The supracondylar area is the weakest point due to transition from cylindrical diaphysis to flat metaphysis, thin cortical bone bridging the columns, olecranon and coronoid fossae creating stress risers, and the supracondylar ridges which mark the proximal extent.
Classification Systems
Adult supracondylar fractures are classified under AO/OTA 13-A (extraarticular distal humerus).
Type 13-A1: Simple Extraarticular
Single fracture line with transverse or short oblique pattern. Subtypes include A1.1 (apophyseal avulsion), A1.2 (simple metaphyseal), and A1.3 (simple metaphyseal with instability).
Type 13-A2: Metaphyseal Wedge
Wedge fragment in metaphysis with more comminution than A1. Subtypes include A2.1 (intact wedge), A2.2 (fragmented wedge), and A2.3 (fragmented wedge with instability).
Type 13-A3: Complex Metaphyseal
Significant comminution with no simple fracture pattern. Subtypes include A3.1 (spiroid pattern), A3.2 (irregular pattern), and A3.3 (irregular with bone loss).
History
Mechanism of Injury
High-Energy (Young Adults)
- Motor vehicle accidents
- Falls from height
- Sports injuries
- Industrial accidents
Low-Energy (Elderly)
- Simple falls from standing
- Osteoporotic fractures
- Minimal trauma in fragility bones
Key History Points
| Question | Relevance |
|---|---|
| Hand dominance | Functional importance |
| Occupation | Manual labor vs sedentary |
| Pre-injury function | Baseline ROM, arthritis |
| Previous elbow surgery | May affect approach |
| Medical comorbidities | Surgical fitness, bone quality |
| Anticoagulation | Bleeding risk, hematoma |
| Smoking status | Wound healing, union |
A thorough history guides surgical planning and informs prognosis.
Examination
Inspection
- Swelling: Significant periarticular swelling
- Deformity: S-shaped (extension) or reverse S-shaped (flexion)
- Skin: Open wounds, tenting, blisters
- Ecchymosis: Anterior (extension), posterior (flexion)
Palpation
- Assess column integrity
- Point tenderness over fracture site
- Crepitus with gentle movement
- Triangle of Hueter: Normal in supracondylar (extraarticular)
Range of Motion
- Do not force examination in acute setting
- Document pre-injury ROM if possible
- Assess elbow and forearm rotation
Special Tests
| Test | Assessing | Normal Finding |
|---|---|---|
| Triangle of Hueter | Articular alignment | Equilateral triangle (preserved in supracondylar) |
| Forearm rotation | DRUJ/PRUJ | Full pronation/supination |
| Elbow stability | Ligaments | Not testable acutely |
Examination must be systematic and documented.
Investigations
Standard Views
AP View
- Assess column integrity
- Measure fracture angle
- Evaluate medial/lateral displacement
- Look for articular involvement (would classify as intercondylar)
Lateral View
- Confirm extraarticular nature
- Extension type: Posterior displacement of distal fragment
- Flexion type: Anterior displacement of distal fragment
- S-shaped deformity (extension type)
- Assess coronoid and olecranon fossa involvement
Radiographic Signs
| Finding | Indicates |
|---|---|
| Posterior displacement | Extension type (95%) |
| Anterior displacement | Flexion type (5%) |
| S-shaped deformity (lateral) | Extension type |
| Fat pad sign | Hemarthrosis (may have less effusion if capsule torn) |
| Intact columns | Good prognosis |
| Column comminution | More challenging fixation |
Full-Length Humerus
Full-length humerus views are required for plate length planning, to exclude proximal extension, and to evaluate for pathologic fracture.
Management Algorithm
Non-Operative Indications
Non-operative management is appropriate for minimally displaced fractures (under 5mm), stable patterns on stress views, non-ambulatory patients with minimal functional demands, and patients with medical comorbidities precluding surgery or patient preference after informed consent.
Operative Indications (Most Cases)
Surgery is indicated for displacement over 5mm, any angulation, unstable patterns, polytrauma requiring mobilization, open fractures, and cases with vascular injury requiring repair.
Surgical Technique
Posterior Approach (Most Common)
Indications
- Complex fracture patterns
- Need for dual column access
- Olecranon osteotomy planned
Technique
- Position: Lateral decubitus or prone
- Midline posterior incision
- Full-thickness flaps
- Identify and protect ulnar nerve
- Access columns via:
- Triceps-splitting
- Triceps-reflecting (Bryan-Morrey)
- Olecranon osteotomy
Advantages
- Excellent exposure
- Allows dual plating
- Can extend proximally/distally
Disadvantages
- Extensile dissection
- Triceps dysfunction risk
- Higher stiffness rates
Lateral Approach (Kocher)
Indications
- Simple lateral column fractures
- Less comminuted patterns
Technique
- Lateral skin incision
- Interval: anconeus and ECU
- Protect radial nerve
- Access lateral column
Medial Approach
Indications
- Isolated medial column fractures
- Ulnar nerve exploration needed
Technique
The medial approach involves a medial skin incision, identification of the ulnar nerve first, protection or transposition of the nerve, then access to the medial column.
Complications
Neurovascular Injury
Ulnar Nerve (Most Common)
- Incidence: 15-20% (neuropraxia)
- Causes: Initial injury, surgical manipulation, hardware
- Management: Observation 3 months, then exploration if no recovery
Radial Nerve
- Incidence: 5-10%
- Causes: Proximal fracture extension, lateral approach
- Management: As above
Vascular Injury
- Less common than pediatric
- Brachial artery at risk anteriorly
- May require vascular repair
Infection
| Type | Incidence | Management |
|---|---|---|
| Superficial | 2-5% | Antibiotics, wound care |
| Deep | 1-3% | Debridement, IV antibiotics |
| Chronic osteomyelitis | Rare | Staged reconstruction |
Wound Complications
Wound issues include skin necrosis (especially with posterior approach), dehiscence, and hematoma. Risk is higher with diabetes, smoking, and anticoagulation.
Postoperative Care
Rehabilitation Protocol
Phase 1: Protection (Week 0-2)
| Goal | Activity |
|---|---|
| Pain control | Multimodal analgesia |
| Wound healing | Dressings, monitor for infection |
| Edema control | Elevation, compression |
| Begin ROM | Passive and active-assisted as pain allows |
| Avoid | Valgus stress, loaded extension |
Phase 2: Early Motion (Week 2-6)
| Goal | Activity |
|---|---|
| ROM progression | Active ROM full arc |
| Forearm rotation | Full pronation/supination |
| Gentle strengthening | Isometrics only |
| Targets | 0-130° flexion/extension arc |
| Splinting | Night extension splint if stiffness |
Phase 3: Strengthening (Week 6-12)
| Goal | Activity |
|---|---|
| Progressive strengthening | Resistance exercises |
| Functional activities | ADLs, light work |
| Continue ROM | Maintain gains |
| Targets | 75% strength of contralateral |
Phase 4: Return to Activity (3-6 months)
| Goal | Activity |
|---|---|
| Full strengthening | Sport-specific or occupational |
| Impact activities | Gradual return |
| Monitoring | Ensure no stiffness regression |
Follow-up Schedule
Postoperative Visits
| Timepoint | Assessment |
|---|---|
| 2 weeks | Wound check, remove sutures, begin ROM |
| 6 weeks | X-ray, ROM assessment |
| 3 months | X-ray, functional assessment |
| 6 months | Final ROM, strength testing |
| 12 months | Discharge if stable |
Imaging Protocol
- 6 weeks: AP and lateral - callus formation
- 3 months: Confirm union progression
- 6 months: Final union confirmation
- PRN: If concern for nonunion or hardware failure
Outcomes and Prognosis
Functional Outcomes
Expected ROM
| Outcome | ORIF | TEA |
|---|---|---|
| Flexion arc | 100-130° | 90-130° |
| Extension loss | 10-30° | 20-30° |
| Pronation | Near full | Near full |
| Supination | Near full | Near full |
Functional Scoring
| Score | Good Outcome Threshold |
|---|---|
| MEPS (Mayo Elbow Performance) | Over 80 points |
| DASH | Under 20 points |
| Grip strength | Over 75% contralateral |
Outcome Predictors
Favorable
- Young age
- Simple fracture pattern
- Good bone quality
- Early ROM initiation
- Compliant patient
Unfavorable
- Elderly
- Comminution
- Osteoporosis
- Delayed treatment
- Smoking
- Diabetes
Return to Activities
| Activity | Expected Return |
|---|---|
| Desk work | 2-4 weeks |
| Driving | 6-8 weeks |
| Light manual work | 3-4 months |
| Heavy manual work | 6+ months |
| Contact sports | 6-12 months |
Long-term Considerations
- Post-traumatic arthritis: 10-20% develop symptomatic arthritis
- Stiffness: Most common permanent sequela
- Hardware removal: May be needed in 10-20%
- Secondary TEA: Salvage for failed ORIF or severe stiffness
Evidence Base
Parallel (Bicolumnar) Plating for Distal Humerus Fractures
- 37 AO/OTA type C distal humerus fractures fixed with precontoured parallel (bicolumnar) plates
- All fractures united with no implant failures at mean 27 months
- Mean flexion-extension arc 97 degrees; mean Mayo Elbow Performance Score 82
- 53% complication rate (24 complications in 17 patients), including 16% postoperative nerve injuries
Perpendicular vs Parallel Locking Plates (Biomechanical)
- Paired osteoporotic cadaveric AO type C2 distal humerus fractures fixed with perpendicular vs parallel locking plates
- Parallel locking system gave significantly greater compressive stiffness (p=0.005) and external-rotation stiffness (p=0.006)
- Parallel construct better resisted axial plastic deformation (p=0.005)
- Both constructs allowed early mobilisation; perpendicular stability was more sensitive to bone mineral density
TEA vs ORIF for Comminuted Fractures in the Elderly (Landmark RCT)
- Multicentre RCT, 42 patients over 65 with displaced intra-articular (OTA 13-C) distal humerus fractures
- 5 of 21 (24%) randomised to ORIF were converted intraoperatively to TEA because fixation was not stable enough for early motion
- TEA gave significantly better Mayo Elbow Performance Score at 2 years (86 vs 73, p=0.015) and better short-term DASH
- Reoperation rates did not differ significantly (TEA 12% vs ORIF 27%, p=0.2)
Olecranon Osteotomy: Union and Hardware Removal
- 70 AO/OTA 13-C distal humerus fractures (42 open) exposed via chevron olecranon osteotomy
- All osteotomies with adequate follow-up united (no nonunions); one delayed union
- Isolated symptomatic osteotomy fixation removal in approximately 8%; any-cause proximal ulnar implant removal in 29.5%
- All achieved satisfactory radiographic articular reduction
Epidemiology and Secular Trend of Distal Humerus Fractures
- Nationwide Finnish data on low-trauma distal humerus fractures in women aged 60 and over, 1970-2007
- Annual fracture number more than quintupled (42 in 1970 to 224 in 1998) then fell to 192 by 2007
- Age-adjusted incidence rose from 12 to 34 per 100,000, then declined to 25 per 100,000
- Fragility distal humerus fractures concentrate in elderly women, paralleling osteoporosis demographics
Viva Scenarios
Use these scenarios to practise clinical reasoning and management decisions
Scenario 1: Low-Energy Fracture in 55F
"A 55-year-old woman presents with a low-energy supracondylar humerus fracture. X-rays show posterior displacement. How would you manage this?"
Initial Assessment:
- Confirm extraarticular pattern (supracondylar not intercondylar)
- Full neurovascular examination - especially ulnar nerve
- CT scan for surgical planning and to confirm no articular involvement
- Assess bone quality - likely osteoporotic at this age
Treatment Plan:
- Operative management indicated - displaced fracture
- Dual column plating via posterior approach
- Locking plates given likely osteoporosis
- Consider cement augmentation if severely osteoporotic
Key Principles:
- Stable fixation to enable early ROM (prevent stiffness)
- Perpendicular or parallel plating both acceptable
- Minimum 6 cortices proximal fixation per column
Scenario 2: Complex Elderly Fracture
"Describe your approach to a comminuted supracondylar fracture in an 80-year-old with rheumatoid arthritis and severe osteoporosis."
Special Considerations:
- Age and osteoporosis: Poor fixation purchase expected
- Rheumatoid arthritis: May have pre-existing joint destruction
- Comminution: Difficult reconstruction
Treatment Options:
- ORIF with dual locking plates: Longest possible plates, maximum distal screw density, consider cement.
- Primary Total Elbow Arthroplasty (TEA): Indicated given age, osteoporosis, RA, comminution. Reliable pain relief.
My Recommendation: Primary TEA would be my preference given the combination of factors. Patient counseling regarding activity restrictions (5kg lifetime limit) is essential.
Scenario 3: Post-Op Stiffness
"Six months post-ORIF of a supracondylar fracture, your patient has 30-100° of flexion. How do you manage this stiffness?"
Assessment:
- Current arc: 70° (30-100°) - functionally limiting
- main deficits: Loss of terminal flexion and extension
- Inv: X-rays (union, HO), CT (if HO suspected), Inflammatory markers (infection)
Management at 6 Months:
- Continue conservative: Intensive physiotherapy, static progressive splinting (extension and flexion).
- Surgical options:
- Arthroscopic release (preferred if no HO)
- Open release (if HO or complex)
Timing: If HO present, wait 12-18 months for maturation. If capsular only, can operate earlier.
Scenario 4: Surgical Technique Viva
"You are planning ORIF for an adult supracondylar fracture. Describe your surgical approach and fixation strategy."
Plan: CT 3D recon. Posterior midline incision.
Approach: Identify ulnar nerve FIRST. Triceps-splitting or reflecting approach (e.g. Bryan-Morrey) or Olecranon Osteotomy for max exposure.
Fixation:
- Anatomic reduction of columns
- Dual plating (medial + posterolateral OR parallel)
- Min 6 cortices proximal, max screws distal
- Checking ROM intra-op
Closure: Layered closure, ulnar nerve transposition if indicated/irritated.
MCQ Practice Points
Q1: Extension Type
Q: In an extension-type adult supracondylar fracture, the distal fragment displaces in which direction?
A: Posteriorly (Answer B). Extension type (95% of cases) has posterior displacement of the distal fragment. The mechanism is axial load with elbow extended, causing the distal fragment to angulate posteriorly. Creates classic S-shaped deformity on lateral view.
Q2: Classification
Q: A supracondylar humerus fracture with involvement of the articular surface should be classified as which AO type?
A: AO 13-C (Answer C). By definition, supracondylar fractures are EXTRAARTICULAR (13-A). Any articular involvement makes it an intercondylar fracture (13-C). This distinction is critical as it changes surgical planning and prognosis.
Q3: Fixation
Q: What is the preferred fixation for adult supracondylar humerus fractures?
A: Dual column plating (Answer C). Dual column plating (perpendicular or parallel) is the gold standard. It provides stability for early ROM, which is critical to prevent stiffness - the most common complication. Single plate fixation has higher failure rates.
Q4: Main Complication
Q: What is the most common complication following adult supracondylar humerus fractures?
A: Stiffness (Answer C). Stiffness is the NUMBER ONE complication, with up to 50% of patients losing functional ROM. This is why stable fixation enabling early ROM is the primary treatment goal. Extension loss is most common.
Q5: Nerve at Risk
Q: Which nerve is most commonly injured in extension-type supracondylar fractures?
A: Ulnar Nerve (Answer C). The ulnar nerve is most commonly affected (neurapraxia) due to its proximity to the medial column and potential tethering in the cubital tunnel. Radial nerve injury is also possible with proximal extension or lateral approach.
Q6: Surgical Exposure
Q: Which surgical approach offers the maximal visualization of the articular surface for complex intra-articular fractures?
A: Olecranon Osteotomy (Answer D). While the triceps-splitting/reflecting approaches preserve the extensor mechanism, an olecranon osteotomy provides the most extensile view of the articular surface, essential for restoring congruity in complex comminuted patterns (AO 13-C3).
Guidelines, Registries & Global Practice
Global Epidemiology
Adult distal humerus fractures show a consistent bimodal distribution worldwide: high-energy injuries in young men and low-energy fragility fractures in older women. Nationwide Finnish registry data (Palvanen et al., Bone 2009) recorded an age-adjusted incidence of low-trauma distal humerus fractures in women aged 60 and over rising from 12 to 34 per 100,000 between 1970 and 1998, then stabilising/declining to roughly 25 per 100,000 by 2007 — a pattern attributed to cohort and fall-prevention effects (DOI). Extra-articular supracondylar (AO/OTA 13-A) patterns make up roughly 10% of distal humerus fractures; the majority are intra-articular (13-C) in elderly cohorts.
Guidance Compared Side by Side
| Body / source | Position on adult supracondylar / distal humerus fractures | Basis |
|---|---|---|
| AO Foundation (AO/OTA) | Bicolumnar (dual-column) fixation of 13-A; restore both columns then absolute/relative stability allowing early motion | Principle-based, supported by biomechanical and clinical series |
| BOA / BOAST (UK) | Open fractures and fragility upper-limb fractures managed on standard BOAST pathways: senior decision-making, early definitive fixation, bone-health referral | Consensus standards |
| NICE (UK, NG38 non-complex fractures) | Early senior-led fixation and early mobilisation; structured rehabilitation; fragility-fracture/osteoporosis assessment | Guideline (consensus, low-grade evidence) |
| AAOS (US) | No dedicated supracondylar guideline; supports anatomic dual-column ORIF, with primary TEA reserved for non-reconstructable fractures in low-demand elderly | Expert consensus + RCT (McKee) |
| EFORT / European consensus | Dual-column locking-plate fixation as default; primary TEA an accepted option in selected elderly | Consensus |
The single highest-level evidence point shared across bodies: in elderly patients with comminuted, non-reconstructable intra-articular fractures, primary semiconstrained TEA gave better 2-year Mayo Elbow Performance Scores than ORIF (McKee et al., Level I RCT — DOI), with a quarter of ORIF-allocated patients converted intraoperatively because stable fixation could not be achieved.
Registry & Implant Evidence
No joint registry tracks plate-fixation outcomes for supracondylar fractures, but national elbow-arthroplasty data inform the TEA-as-primary-treatment decision. Registries including the NJR (England & Wales), AOANJRR (Australia), AJRR (USA), SHAR/Swedish and NZJR report total elbow replacement as a low-volume procedure with higher revision rates than hip or knee arthroplasty and meaningful early failure when used for acute trauma — reinforcing that primary TEA is reserved for genuinely low-demand patients who can accept a lifelong lifting restriction.
Practice Variation
- High-resource settings: routine CT, precontoured anatomic locking plates, and selective primary TEA; early supervised physiotherapy to combat stiffness.
- Limited-resource settings: conventional reconstruction/one-third tubular plates or non-operative management of stable patterns are more common; TEA and revision capacity are scarce, raising the threshold for arthroplasty.
- Ulnar nerve handling (in-situ decompression vs routine anterior transposition) varies between surgeons and regions without consistent evidence of superiority for routine transposition.
Adult Supracondylar Fractures
Clinical summary
Definition & Classification
- •Extraarticular distal humerus fractures in metaphyseal region
- •AO/OTA 13-A (extraarticular): A1 simple, A2 wedge, A3 complex
- •Any articular extension = Intercondylar (AO 13-C)
- •Extension type (95%) vs Flexion type (5%)
Key Exam Concepts
- •Stiffness is THE major complication (vs deformity in kids)
- •Dual column plating is gold standard fixation
- •Minimum 6 cortices proximal fixation per column
- •Primary TEA valid for elderly, osteoporotic, comminuted
Crucial Management Steps
- •CT Scan standard for surgical planning
- •Identify Ulnar Nerve early in posterior approach
- •Rigid fixation (LOCKING in osteporosis) allows early ROM
- •Pre-drill olecranon osteotomy before cutting
Common Pitfalls
- •Confusing supracondylar (extraarticular) with intercondylar
- •Using single plate fixation (high failure rate)
- •Delaying ROM leads to Stiffness (50% incidence)
- •Missing ulnar nerve palsy or vascular injury