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Elective diaries: A 4-year-old boy with a supracondylar humerus fracture

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During my elective with Medics Abroad in Malindi Kenya, my team received a 4-year-old boy with a Gartland type III closed supracondylar humerus fracture occurring in the transverse plane.

Such fractures do not heal correctly with casting or splinting alone and therefore require open reduction and internal fixation (ORIF) surgery. This two-part surgery consisted of re-aligning the displaced bone (open reduction) and securing it in place with hardware (internal fixation). It is important to isolate the ulnar nerve prior to hardware placement to avoid any iatrogenic nerve injury. Once the bone is set, a cast is applied to restrict mobility, thereby aiding the healing process.

Both the cast and wires are removed after three weeks in order to commence physiotherapy and prevent the development of a stiff elbow.

It is worth noting that a closed reduction is preferred, however due to limited resources only an open procedure could be performed.

A little bit about fractures in general

Classification of fractures:

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Open (compound) vs. closed (simple)

Open fractures penetrate the skin, posing a greater risk for infections whereas the overlying skin remains intact in closed fractures.

  • Vertical
  • Transverse
  • Oblique
Location (elbow)
  • Supracondylar fracture: occurs in the humerus, just above the elbow joint and are the most common type of elbow fracture seen by pediatric orthopedic surgeons. Because the brachial artery (the main artery in the upper arm) and the nerves that control the movement of the hand sit along this bone, these fractures are also associated with an increased risk of vascular and nerve injury.
    • Gartland sub-classification based on the degree and direction of displacement, and the presence of intact cortex:
      • Undisplaced or minimally displaced
      • Displaced bu with intact cortex
      • Completely displaced
  • Lateral condyle fracture: occurs at the outer part of the elbow, an area that serves as an attachment point for most of the muscles that extend the wrist and fingers, and also for the ligaments that stabilize the elbow joint.
  • Medial epicondyle fracture: occurs on the inner part of the elbow (the side closest to the body). Like the lateral epicondyle, the medial epicondyle is an important attachment point for forearm muscles – in this case, those that flex the wrist and fingers.

Featured image: Orthobullets

Samaher Al Binali

The author Samaher Al Binali

Samaher is a medical student at the Royal College of Surgeons in Bahrain (RCSI Bahrain).

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