Musculoskeletal case studies for medical students
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Supracondylar fracture of the left distal humerus.
The capitellum should be on a line drawn down the anterior humeral shaft. In this case the distal humerus is displaced posteriorly. This means a reduction is needed.
Under general anaesthesia a closed reduction was done. More than 90 degrees of elbow flexion was possible and the radial pulse remained palpable in this position. A backslab was applied for immobilisation.
If the radial pulse disappears after flexing the elbow, percutaneous kwires may be neceaasry to stabilise the fracture. It can then be immobilised in a more extended position that allows better perfusion (a position where the radial pulse is again palpable). Dunlop traction is an acceptable alterative to percutaneous K wires. If this is used, a second reduction, after a few days to allow swelling to subside, will probably allow easy reduction.