![]() So when the proximal fragment is displaced posteriorly the ulnar nerve gets affected. As you can see in the upper diagram the ulnar nerve crosses the elbow posteriorly to the medial epicondyle of the humerus. Is most commonly injured in the flexion type of supracondylar fractures because in flexion type supracondylar fractures the proximal fragment is displaced posteriorly. So when the proximal fragment is displaced anterio-laterally the radial nerve gets affected. As you can see in the upper diagram the radial nerve lies anteriorly and laterally to the supracondylar region. This happens because the proximal fracture fragment is displaced anterio-laterally. ![]() Is most commonly injured when the distal humerus is displaced posteromedially. ![]() While Ulnar nerve passes posteriorly to the medial epicondyle of the humerus. When a neurological involvement is mentioned, it warrants a very careful examination and documentation for example when it first became evident, the degree of involvement and desirable progression/regression of symptoms.Īs in the diagram, you can see that the Radial and Median nerve passes anteriorly ie upper to the supracondylar region. Because by performing a neurovascular exam you will get to know that whether the artery(brachial artery) or nerves(Radial, Ulnar, and Median nerves) got stuck into the fracture site.Ĭlinical trials like the temperature of the limb extremities (cold or warm), oxygen saturation on the pulse oximeter of the affected limb, capillary refilling time, the presence of the radial and ulnar pulses, and also some other wounds that would signal open fracture.ĭoppler ultrasonography should be performed in case of vascular injury if distal or radial pulses are not palpable. It becomes very crucial to do a neurovascular exam before performing any reduction maneuver. It happens by falling over the tip of the elbow or falling with the arm twisted behind the trunk. Meanwhile, the flexion-type of supracondylar humerus fracture is not much common. And if in case any of them got injured it can give rise to major complications. Many important nerves and artery like (Median nerve, Radial nerve, Ulnar nerve, Brachial artery) lie in the supracondylar region. The supracondylar area undergoes remodeling in age 6 to 7, which makes this region thin and susceptible to fractures. The olecranon functions as a fulcrum which focuses the strain on the distal humerus (supracondylar region), predisposing the distal humerus to break. And as the hand strikes the ground, the elbow is forced into hyperextension. The most common mechanism of injury is an Extension type and it occurs due to falling on an outstretched hand. And also they are very unstable both in flexion type as well as in extension type i.e., they’ve multidirectional instability. Type IV fractures –Have no periosteal hinge intact (complete periosteal disruption). III B fractures – Distal fragment is displaced posterolaterally but has a lateral periosteal hinge intact. III A fractures – Distal fragment is displaced posteromedially but has a medial periosteal hinge intact There are generally two types of Type III supracondylar fractures But they have a periosteal hinge intact either medial periosteal hinge intact or lateral periosteal hinge intactĪn intact periosteal hinge allows the orthopedic surgeon to reduce the fracture by reversing the rotational injury. The distal fragment is displaced posteriorly, and there is no cortical contact. Displaced having an angulation, but maintain an intact posterior cortex
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