72.10 Supracondylar fractures of the humerus in adults

Supracondylar fractures in adults differ from those in children, and are caused in a different way: (1) An old person falls and strikes his elbow on the ground. The force of the blow drives his ulna up against his humerus and either breaks off its lower end, as in a child, or, more often, splits it into two or more pieces which may separate widely and displace backwards or forwards. Or, (2) the patient rests his arm on the window of his car, and has it crushed by a passing vehicle (sidewipe fracture). In either case he cannot move his swollen and deformed elbow. Swelling obscures the bony landmarks and if you examine it carefully, you may be able to feel crepitus.

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Figure 72.14: TRACTION THROUGH THE OLECRANON FOR A T–SHAPED SUPRACONDYLAR FRACTURE. If a patient’s olecranon is intact, pass a Kirschner wire through it (70.10), and tension the wire with a Gissane stirrup (1), or, less satisfactorily, use a thin (less than 4 mm) Steinmann pin. After de Palma with kind permission.

These fractures are usually T–shaped or comminuted. Rarely, they are transverse as in children; if so, you can manage them in the same way. If the fracture is T–shaped or comminuted, you cannot reduce the fragments by closed manipulation, and they are difficult to fix at open operation. Even when the fragments are fixed internally, the late results are often disappointing, so it is fortunate that the results of early active movement are usually better as shown in Fig. 72-13, and that patients have much less osteoarthritis than you might expect. But the results will only be better, if the patient really does start moving his elbow early. The function he will ultimately get depends on the relationship of his two condyles. If they are widely apart and shifted on one another, movement will be poor. If they are parallel and not shifted, movement will be better. Displacement of the fragments at the transverse fracture is less important. You can combine active movements with traction, as in Fig. 72-14.