Fractures of the distal end of the humerus
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AO classification[edit | edit source]
A – extraarticular (avulsive a supracondylar)
B – partially intra-articular
C – completely intra-articular
Other classifications[edit | edit source]
A. Supracondylar (extraarticular)[edit | edit source]
- Occur mainly in children in falls when forces act indirectly or directly on the elbow in the sense of hyperflexion or hyperextension.
- Division
- Extension:
- More common, distal fragment dislocated dorsally, anterior fragment may injure the a. brachialis;
- high risk of forearm compartment syndrome and development of Volkmann's ischemic contracture..
- Flexion:
- distal fragment dislocated ventrally.
- Treatment
- Conservative (with intact innervation and blood supply):
- repositioning by traction and flexion for the extensor type, traction and extension for the flexor type;
- application of a circular plaster cast (in supination and flexion for the extension type, in extension for the flexion type) - must not press in the elbow socket, checking blood supply and innervation in the periphery - for 4 weeks.
- Surgery:
- fixation with two crossed Kirschner wires inserted percutaneously.
B. Intercondylar (intra-articular)[edit | edit source]
- more common in adults;
- arise from a fall on a flected elbow;
- the fracture line is T- or Y-shaped;
- dislocated fractures are treated surgically (open repositioning and OSY with screws and splints);
- only non-dislocated fractures are treated conservatively.
Clinical signs and diagnosis[edit | edit source]
- Significant swelling and haematoma of the ulnar landscape, pain on elbow movement; clinically, the epicondyle and olecranon do not form a straight line (in elbow extension) or an isosceles triangle (in elbow flexion).
- It is necessary to check peripheral blood supply to the a. radialis (possible injury to the a. brachialis) and innervation of the n. radialis.
- X-ray (mainly lateral projection).
Complications[edit | edit source]
- Volkmann's ischemic contracture;
- limitation of elbow mobility - mainly due to paraarticular ossifications;
- angular deformities - cubitus varus et valgus.
References[edit | edit source]
Related articles[edit | edit source]
Source[edit | edit source]
- PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2022-17-12]. <http://langenbeck.webs.com>.
