Most common type of supra condylar fracture in children ?
Ans. is 'a' i.e., Posteromedial extension Supracondylar fracture of humerus Supracondylar humeral fractures are the most common elbow fractures in children. Most common age group affected is 5-8 years. Boys are affected more than girls. Left side is more common than right. Mechanism of injury Mostly it occurs due to hyperextension injury. Fracture is caused by a fall onto the outstretched hand with hyperextension at elbow. Types of supracondylar fracture Supracondylar fracture is broadly classified into extension type and flexion type. 1) Extension type It is the most common type (97 - 99%). Distal fragment is extended (tilted backward/posteriorly) in relation to proximal fragment. Occurs due to hyperextension injury after fall on outstretched hands. Generally, displacement of distal fragment may be : - i) Posteromedial (70-80%) ii) Posterolateral (20-30%) 2) Flexion type It is less common type (1-3 %) Distal fragment is flexed (tilted forward/anteriorly) in relation to proximal fragments. The mechanism of injury generally is believed to be a fall directly onto the elbow rather than a fall on outstretched hand. As the extension type fracture is more common (97 - 99%), the most common elbow injury in children is extension type of supracondylar fracture. Clinical features of supracondylar fracture Following a fall, the child is in pain and elbow is swollen. In extension type of injury, `S' shaped deformity of the elbow is obvious. There is loss of both active and passive movements of elbow. Symptoms relating to vascular and nerve injury may be seen. Unusual posterior prominence of the point of elbow (tip of olecrenon) because of backward tilt of the distal fragment. Three point bony relationship is maintained as the fracture is above the level of condyles. Dimple sign due to one of the spikes of proximal fragment penetrating the muscle and tethring the skin.
Posteromedial extension
Posterolateral extension
Anteromedial flexion
Anterolateral flexion