Supracondylar Humerus Fractures Workup

  • Author: Mark A Noffsinger, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Feb 7, 2012
 

Imaging Studies

  • Adequate radiographs must be obtained to evaluate the fracture anatomy and to plan for surgical treatment.
    • Radiographs should include routine AP and lateral films, possibly including additional studies (eg, oblique views). See image below. Radiographs of a type III-C distal humerus fracturRadiographs of a type III-C distal humerus fracture 5 months postinjury and fixation using olecranon osteotomy approach and medial and posterolateral plates. Range of motion -10 to 140 degrees without pain.
    • With comminuted bicolumn fractures (AO-ASIF C3), repeat films following initial reduction or with longitudinal traction maintained often prove helpful to further define articular fracture fragments.
  • CT scan can also be helpful for surgical planning for complicated fractures.
  • In cases in which concern exists about vascular injury, arteriograms are of benefit.
  • In cases of neurologic injury, EMG is generally not helpful until approximately 3 months post injury. Then it may serve as a helpful baseline to which to compare for progress.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mark A Noffsinger, MD  Clinical Instructor, Department of Orthopedic Surgery, Michigan State College of Human Medicine; Medical Director, Department of Orthopedic Surgery, Bronson Methodist Hospital, Consulting Staff, Kalamazoo Orthopedic Clinic

Mark A Noffsinger, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Orthopaedic Medicine, American College of Physician Executives, American Fracture Association, American Medical Association, American Medical Directors Association, Christian Medical & Dental Society, Indiana State Medical Association, International Society on Thrombosis and Haemostasis, Michigan State Medical Society, Mid-America Orthopaedic Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey L Visotsky, MD  Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Samuel Agnew, MD, FACS  Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

References

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Supracondylar humerus fractures, anatomy. The trochlea rests in 6-8 degrees valgus in relation to the humeral shaft.
Supracondylar humerus fractures, anatomy.When viewed on end, the trochlea resembles a spool.
Supracondylar humerus fractures, anatomy.Note the medial and lateral columns, connected by the trochlea, thus forming the triangle of the distal humerus. Also note the location of the sulcus for the ulnar nerve in relation to placement of the medial plate, and the location of the radial nerve sulcus in relation to proximal placement of plates.
An incision is made along the proximal 5 cm of the medial ulnar border, curving to the medial side of the olecranon, and returning to midline posteriorly to approximately 15-20 cm above the elbow joint.
The nerve is traced distally and released from the cubital tunnel and into the flexor muscle mass; care is taken to avoid the motor branch to the flexor carpi ulnaris. Articular branches need to be sacrificed for later anterior transposition. The nerve then is carefully retracted and protected with a vascular tape.
The cut is made with an oscillating saw and completed with a sharp osteotome to prevent damage to the articular surfaces. A gauze sponge can be inserted into the joint prior to osteotomy completion to further protect the articular cartilage. The olecranon, with the intact triceps insertion, is reflected posteriorly and covered with moist sponge, allowing easy access to the entire supracondylar and to joint surfaces.
Between postoperative days 10 and 14, sutures are removed, and if the wound is stable, the patient is placed in a hinged elbow orthoses, and protected active range of motion is allowed. Passive assisted range of motion is allowed to the point of discomfort, not pain. The importance of early range of motion to final outcome has been well documented. The orthosis is worn until evidence (both clinical and radiographic) of fracture union is present, and then orthosis use is discontinued. This usually occurs 6-12 weeks postoperatively.
Radiographs of a type III-C distal humerus fracture 5 months postinjury and fixation using olecranon osteotomy approach and medial and posterolateral plates. Range of motion -10 to 140 degrees without pain.
 
 
 
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