Clinical manifestations and complications of supracondylar fracture of humerus

Children have a history of hand injury, elbow pain, swelling, subcutaneous ecchymosis, elbow protruding backward, showing a semi-flexion position. We should consider the possibility of supracondylar fracture of humerus. The local tenderness is obvious, with bone rubbing sound and pseudo-joint activity, the fracture end can be reached in front of the elbow, and the triangle relationship behind the elbow is normal. Generally, the proximal folded end moves forward and downward, and the distal folded end moves upward. Attention should be paid to whether there is neurovascular injury during diagnosis, and special attention should be paid to the degree of forearm swelling, wrist radial artery pulsation, hand feeling and motor function.

2. Buckling types

After injury, local swelling, pain, elbow joint protrusion, subcutaneous ecchymosis. Examination can find tenderness above the elbow, and then palpate the fracture end. X-ray film can find the existence of fracture and typical fracture displacement, that is, the proximal end of fracture moves backward and downward, the distal end of fracture moves forward, and the fracture line is oblique from front to back. There are fewer patients with vascular and nerve injuries.

X-ray film of elbow joint is necessary, which can accurately judge fracture displacement and provide basis for diagnosis and treatment.

3. Complications (extended type)

(1) Vascular injury: because the proximal end of the extended supracondylar fracture of humerus moves forward and downward, it is easy to compress or puncture the brachial artery, and the tissue reaction after the injury will cause severe local swelling, affect the blood circulation of the distal limb, and lead to forearm osteofascial compartment syndrome. If diagnosis and correct treatment are not made in the early stage, ischemic muscle contracture can be caused in the later stage, which will seriously affect the function of hands and the development of limbs.

(2) Nerve injury: ① Radial nerve injury; ② Ulnar nerve injury; ③ Median nerve injury.