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We Must Save Our EarthBefore That

We Must To Learn Orthopedic

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JOURNAL READINGPRIMARY RUPTURE OF BRACHIAL

ARTERY AND MEDIAN NERVE

IN SUPRACONDYLAR FRACTURE

OF THE HUMERUS

By:

Faza Khilwan Amna

Preceptor:

dr. L. Hartoko B. Sp.OT

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SUMMARY

DISCUSSION

CASE

BIBLIOGRAPHY

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CASE

He was found to have closed fractures of both bones of the left forearm

Swollen antecubital region

There was no pulse at the wrist

The colour of the hand was good

Nerve Function normal

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Cont

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Cont

The median nerve was found caught and kinked between the

fragments, in contact with the jagged edges of the upper

the brachial artery there was at first no sign, but after a search itsproximal severed end was found and tied

The biceps tendon was intact, although the lacertus fibrosus had

been torn

The median nerve was freed and the fracture was reduced under

direct vision

The small punctum was excised and the antecubitalfossa opened anteriorly

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Cont

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Post Operative???

Cont

Post-operative progress was uncomplicated

The circulation in the hand was never a source of anxiety, though a

palpable radial pulse did not return for two months.

There was slight partial sensory impairment in the fingers, and motorweakness of median distribution

Eight months after the injury there was full extension of the elbow,

flexion to twenty degrees beyond the right angle, and a good range

of rotation

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Cont

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OTHER CASE

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Rupture of the brachial artery in supracondylar fractureis rare

Arterial rupture seems rather more common in

association with dislocation ofthe elbow

Rupture of the median nerve in supracondylar fracture iseven rarer than arterial rupture

Occurs Volkmanns ischaemic contracture

OTHER CASE

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SUMMARY

DISCUSSION

CASE

BIBLIOGRAPHY

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DISCUSSIONANATOMICAL CONSIDERATIONS

Operative experience:

1. The position and direction of the biceps tendon

2. The mechanism and direction of the fracturing force

which, with the elbow extended, will tend to direct the

humerus medially in relation to the forearm

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Prevention of median nerve involvement is largely a

problem concerned with the efficient reduction ofsupracondylar fractures

Ischemic contracture was excessively rare without

unreduced gross displacement

The first symptom of the arterial block dates more oftenfrom a manipulation than from the fracture itself

ContDANGERS OF MANIPULATION

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Using a technique of manipulation based on anatomical

knowledge of the fracture, there should never be anynecessity for open reduction, except for nerve or arterial

complications

A careful open operation may well be preferred to

continuous traction or mechanical traction Objectives at operation as threefold: to evacuate the

hematoma, to safeguard the neurovascular bundle and

to obtain accurate reduction

ContOPEN REDUCTION

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SUMMARY

DISCUSSION

CASE

BIBLIOGRAPHY

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SUMMARY1. A case, believed to be the fifth on record, of supracondylar fracture

with rupture of the brachial artery is described.

2. The relative immunity of the median nerve in these injuries is

discussed, with brief reference to a recent case of complete rupture.Only a single previous report of this complication could be found.

3. It is suggested that these injuries are less uncommon than the

number reported would indicate.

4. The anatomy of severe displacement is discussed, with special

reference to the role of the brachialis.5. The danger of closed reduction when the relationship of the upper

fragment to the neurovascular bundle is in doubt is stressed.

6. The indications for open reduction are given.

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SUMMARY

DISCUSSION

CASE

BIBLIOGRAPHY

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BIBLIOGRAPHYBOHLER, L. The Treatment of Fractures. Fourth English edition, p. 196. Bristol: John Wright & Sons

Ltd.

CHARNLEY, J. The Closed Treatment of Common Fractures, p. 58. Edinburgh: E. &S. Livingstone Ltd.

ELIASON, E. L., and BROWN, R. B. Posterior Dislocation at the Elbow with Rupture of the Radial and

Ulnar Arteries. Annals of Surgery, 106, 1,111.

FAGGE, C. H. Supracondylar Fracture of the Humerus. British Medical Journal, i, 604.

FAIRBANK, H. A. T. Supracondylar Fracture of Humerus. British Medical Journal, i, 501.

GRIFFITHS, D. Li. Volkmanns Ischaemic Contracture. British Journal of Surgery, 28, 239.

HENDERSON, R. S., and ROBERTSON, I. M. Open Dislocation of the Elbow with Rupture of the

Brachial Artery. Journal of Bone and Joint Surgery, 34-B, 636.

LIPSCOMB, P. R., and BURLESON, R. J. Vascular and Neural Complications in SupracondylarFractures of the Humerus in Children. Journal of Bone and Joint Surgery, 37-A, 487.

MADSEN, E. Supracondylar Fractures of the Humerus in Children. Journal of Bone and Joint Surgery,

37-B, 241.

SPEAR, H. C., and JANES, J. M. Rupture of the Brachial Artery Accompanying Dislocation of the

Elbow or Supracondylar Fracture. Journal of Bone and Joint Surgery, 33-A, 889.

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