$supracondylar fracture of humerus in adults$

$supracondylar fracture of humerus in adults$

Flattening of the humerus distally, the presence of the olecranon and coronoid fossae, the neurovascular structures in close proximity to the elbow and some physiological angulations that must be preserved make the surgical procedure difficult.With posterior approach,using single low contact dynamic compression plateleft limited number of holes for distal fragment fixation,which was not adequate hence we resorted to dual long locking plates(8,9).The optimal timing for initiating surgical distal humerus fractures remains controversial with some surgeons advocating emergency surgery within 24 hours of injury(8,9). The treatment of distal humeral fractures with extension into humeral shaft presents a challenge to the orthopaedic surgeon(6,7,8). One of the patient who had developed radial nerve palsy in the form of neuropraxia,recovered during the course of follow up.At the end of follow up all patients have adequate clinical and radiological fracture union and functional range of motion at elbow and shoulder joint. Patients were reviewed at 3 weeks, 6weeks,3months and 6months. Intraoperatively,fracture reduction was relatively stable and no post-operative splintage was given.Fracture pattern was non-comminuted and hence no bone grafting was required.Gradual mobilisation at elbow and shoulder was started from forty-eight hours post surgery. A midline posterior triceps splitting approach was used in all the three cases. With patients placed supine, pneumatic tourniquet applied after general anaesthesia,the upper limb was placed in front of the chest, with the shoulder and elbow in flexion. Initially in the emergency, the arm was temporarily immobilized in an above elbow plaster slab.Open fracture was operated within six hours and other two were operated after five days once the swelling subsided. Antero-poaterior and lateral radiographs of elbow with humerus showed supracondylar fracture extending into humeral shaft. Three point congruency was maintained in all the three cases. MethodsĪll three cases reported to our emergency department sustaining road traffic accident with fall onto outstretched hand.Amongst them,two were males and one female and mean age was 52.4.They complained of pain and swelling in distal part of the arm.Clinical examination revealed two closed fractures and one open fracture with grade 1 injury(Gustillo-Anderson classification).On examination tenderness,abnormal mobility and crepitus was present in the distal humerus without neurovascular deficit. Here,we present three cases of supracondylar fracture with extension into shaft which was treated with bicolumnar plating(3,4). Internal fixation of these fractures with a single plate is technically difficult and fracture fixation is not stable. Presence of comminution, significant soft tissue trauma and injury to neurovascular bundle further complicate the management.supracondylar fractures with fracture line extending into shaft are rare.Surgical treatment is preferred in these cases. Introductionĭistal humerus fractures are rare and difficult injuries to manage due to the complex three-dimensional geometry of the distal humerus which poses a considerable challenge to reconstruction(1,2).

$supracondylar fracture of humerus in adults$

Here we describe our experience treating distal humerus fractures using a triceps splitting approach with bicolumnar locking plate fixation.

$supracondylar fracture of humerus in adults$

Supra-condylar humerus fractures with extension into shaft are difficult to treat and typically require open anatomical reduction and internal fixation.

$supracondylar fracture of humerus in adults$

Supracondylar fracture of humerus in adults