Cubitus varus deformity in supracondylar fracture of humerus is usually due to
Ans. c (Coronal tilt) (Ref. Bailey & Love surgery, 24th/pg. 375; Orthopedics by John Ebnezar - Pg.155)Malunion (gunstock deformity/cubitus varus) can result from tilt in the coronal plane, and is the most common late complication of supracondylar fracture.SUPRACONDYLAR FRACTURE OF HUMERUS# There are two types of supracondylar fracture--the extension type (95%), in which the anterior cortex fails first with resultant posterior displacement of the distal fragment, and the flexion type, in which the opposite occurs.# Extension type supracondylar fractures are classified using Gartland's classification:- Type I fractures are nondisplaced,- Type II fractures are displaced but hinged on the posterior cortex, and- Type III fractures are completely displaced, as in this case (have potentially serious complications).Early Complications# Vascular damage- As the distal fragment and forearm are pushed backward, the brachial artery and median nerve are pulled violently against the sharp lower edge of the proximal fragment. Circulation must be assessed looking for pulselessness, pallor, pain, paresthesia, and paralysis (the five p's), and capillary refill.# Compartment syndrome# Nerve damage- The median, radial, and ulnar nerves may be injured, with potential long-term pain and functional deficit. Fortunately, the injury is usually a neuropraxia, which recovers with conservative treatment.# Myositis ossificansLate Complications# Volkmann's ischemic contracture# Malunion- Cubitus varus (gun stock deformity) is the most common long-term complication resulting from a malunion of a supracondylar fracture of the humerus in children.- The deformity occurs as a result of residual coronal angulation. Corrective supracondylar osteotomy is performed mainly to improve the cosmetic appearance and not for functional reasons. The most popular method was lateral closing wedge osteotomy but it needs detailed preoperative planning, careful surgical technique but can still cause recurrent varus and lateral condylar prominence in older children.- In Dome osteotomy vulnerability of the radial nerve is the problem. Osteotomy with T-plate fixation gives very good correction of varus deformity, with stable fixation and good functional result but care must be taken to avoid injury to the radial nerve.# Supracondylar fracture of humerus undergoes medial tilt and can lead to varus deformity.- It can cause tardy ulnar nerve palsy.Rx of Supracondylar Fracture:
Posterior displacement
Posterior angulation
Coronal tilt
All of the above
Injuries Around Arm & Elbow