What's the diagnosis? By Dr. Geno Marrone
A 76 yo female presents after a fall on an outstretched right arm. She has right elbow pain, tenderness, and swelling. An xray is shown. What's the diagnosis? Scroll down for answer.
Answer: Supracondylar fracture of the distal humerus
- Most commonaly, a fall on an outstretched arm
- Type I: undisplaced
- Type II: displaced with intact posterior cortex
- Type IIa: no rotational deformity
- Type IIb: rotational deformity
- Type III: complete displacement
- Clinical signs/symptoms
- Pain on passive extension of elbow
- Usually a forearm held in pronation
- Sail sign: anterior fat pad is elevated by a joint effusion, appears as a lucent triangle on the lateral projection
- Posterior fat pad sign, a lucency in the olecranon fossa on the true lateral elbow xray with elbow flexed at 90 degrees
- Anterior humeral line should intersect the middle third of the capitellum on the ture lateral xray.
- Type I: stable, immobilization and prompt out patient orthopedic follow up
- Type IIa: immobilization flexed at 120 degrees vs surgical pinning
- Type IIb: reduction +/- fixation
- Type III: Closed reduction and percutaneous pinning vs open reduction
- Volkmann ischemic contracture: forearm compartment syndrome due to damage/occlusion of the brachial artery
- damage to the ulnar, median or radial nerves
- most commonly anterior interosseous nerve (branch of the median nerve) causing weakness of hand flexors (difficulty making the OK sign) and abduction of the thumb
Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.