Supracondylar Humerus Fractures Clinical Presentation

Updated: Aug 23, 2019
  • Author: Jiun-Lih Jerry Lin, MBBS, MS(Orth); Chief Editor: Jeffrey D Thomson, MD  more...
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Presentation

History and Physical Examination

The clinical presentation of a supracondylar humerus fracture (SCHF) is that of a painful swollen elbow that the patient is hesitant to move. The elbow may appear angulated and the upper extremity shortened. Some series report that open wounds are present in as many as 30% of these fractures. Patient history includes a high-energy trauma or significant fall. Evaluate adjacent joints for associated injuries.

Neurovascular status must be carefully evaluated and monitored. Owing to the close proximity of the neurovascular structures, injury is not uncommon. If a deficiency is noted, carefully evaluate and document when it first became apparent, the degree of involvement, and possible progression. If it first appeared following manipulation or splint placement, consider remanipulation; if the deficiency does not resolve, urgently explore to evaluate possible nerve entrapment. Neurapraxias are not uncommon and generally resolve with restoration of normal alignment and lengths. In the author's experience, resolution has occurred up to 18 months after injury.

Radiographic evaluations (see Workup) should include standard anteroposterior (AP) and lateral films. With comminuted bicolumn fractures (type C3 in the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation [AO-ASIF] classification; see Classification), repeat films following initial reduction or with longitudinal traction maintained often prove helpful in further defining articular fracture fragments. For complicated fractures, computed tomography (CT) also can be helpful with regard to surgical planning.

If vascular compromise is evident, obtain emergency arteriograms. If arterial disruption is present, obtain a vascular surgery consultation followed by immediate open reduction and internal fixation (ORIF) to provide skeletal stability and support of vascular reconstruction.

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Classification

AO-ASIF classification

AO-ASIF type A fractures are extra-articular fractures and are further subclassified as follows:

  • A1 - Epicondylar avulsions
  • A2 - Supracondylar fractures
  • A3 - Supracondylar fractures with comminution

AO-ASIF type B fractures are unicondylar fractures and are further subclassified as follows:

  • B1 - Fracture of the lateral condyle
  • B2 - Fracture of the medial condyle
  • B3 - Tangential fracture of the condyle

AO-ASIF type C fractures are bicondylar fractures and are further subclassified as follows:

  • C1 - T-shaped or Y-shaped fractures
  • C2 - T-shaped or Y-shaped fractures with comminution of one or two pillars
  • C3 - Extensive comminution of the condyles and pillars

This classification remains somewhat deficient in describing the mechanically important concept of the medial and lateral columns and their fracture involvement. It also is somewhat deficient in describing the level through which the fracture occurs in each column and related important surgical considerations.

Mehne-Matta classification

In view of the aforementioned limitations of the AO-ASIF classification, the author believes that the classification of bicolumn fractures of the distal humerus introduced by Mehne and Matta proves useful in planning bicolumn surgical fixation.

The classification of Mehne and Matta describes the specific characteristics of bicolumn fractures and allows for better preoperative planning. [9] The classification is as follows:

  • High T fracture
  • Low T fracture
  • Y fracture
  • H fracture
  • Medial lambda fracture
  • Lateral lambda fracture

Although the medial and lateral lambda fractures are not technically bicolumn fractures, they are included in this classification because they require similar operative fixation techniques.

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