Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Fracture of the Lower End of the Humerus (Supracondylar Fracture)

Children often sustain fractures of the lower part of the humerus because of falls from gymnasium apparatus, and in riding or cycling falls.

Symptoms and diagnosis

– Intense pain is felt during arm movements.
– There is tenderness on pressure.
– Swelling and bruising are noticeable.
– Contour changes.

Treatment

The injured person should be taken to a doctor as quickly as possible. Fractures of the lower part of the humerus very often require hospital treatment, especially in children or adolescents, as the important nerves and blood vessels situated near the broken ends of the bone can be affected by the resultant bleeding and are vulnerable to damage. Pulse and sensation below the injury should be checked.

The doctor will attempt to realign the fractured bones, and if this is not possible, surgery may be necessary.

Healing

Mobility exercises are started at an early stage if the injury is not too serious. After 8–10 weeks, when full mobility of the arm has been regained, sporting activity can be resumed.

Arthroscopy

Arthroscopy is more and more commonly used for diagnosis and treatment of many elbow injuries. By avoiding a large capsular excision, many of the problems of postoperative scarring and capsular contraction of the elbow can be avoided.

Elbow arthroscopy should be performed slowly and deliberately, by a surgeon who is experienced in sports medicine. Usually a 4 mm, 30° angle arthroscope provides optimal visualization of the elbow;
sometimes a 1.6mm flexible arthroscope can be used. The anterolateral portal, 2 cm distal and 3 cm anterior to the lateral epicondyle, is commonly used. The lateral and posterior antebrachial cutaneous
nerves must be avoided. The instrument should be directed toward the center of the elbow with the elbow flexed at 90° at all times. The arthroscopic instruments pass within a mean distance of 4 mm of the radial nerve regardless of the flexion or extension of the elbow when the elbow is not extended with fluid. However, when 35–40 ml of fluid is inserted into the elbow capsule, the radial nerve moves an additional 7 mm anteriorly. The maximum distention of the elbow should be maintained at all times, particularly when established in initial arthroscopic portals.

Through a medial portal, 2 cm proximal and 1–2 cm anterior to the medial epicondyle, the radial head and the capitellum can be well visualized. The medial antebrachial cutaneous nerve should be avoided.

The posterolateral portal is sited 3 cm proximal to the olecranon superior and posterior to the lateral epicondyle. The olecranon fossa and tip of the olecranon can be seen as well as the distal humerus. It should be remembered that this portal is established with the elbow at 20–30° of flexion.

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