A 7 year old girl presented with a painful elbow following a fall.X ray shows the folowing features.Most common nerve involved in this condition is?
A. Radial Nerve
B. Median Nerve
C. Ulnar Nerve
D. Anterior Interosseus Nerve
Ans:D. Anterior Interosseus Nerve.
The patient in question is suffering from Supracondylar fracture of Humerus.
FRACTURE SUPRACONDYLAR HUMERUS (MALGAIGNE’S FRACTURE)
- Most common fracture around elbow in children and adolescent
- Most common fracture associated with vascular injury, M/c fracture to involve brachial artery.
- Most common cause of Volkmann’s ischemia & compartment syndrome in children.
- Most common cause of Volkmann’s ischemic contracture.
- Commonly involves 3-10 years age group
- Displacement: Commonly distal fragment has following displacements
- Posterior (Dorsal or backward) tilt and shift
- Proximal shift
- Medial tilt
- Medial / Lateral shift
- Internal rotation
- M/C mechanism of injury is fall on the outstretched hand with elbow in full extension.
- ‘S’- shaped deformity of arm
- Unusual posterior prominence of tip of Olecranon
- Three point bony relations (of lateral & medial epicondyles and tip of Olecranon) maintained in relation to each other but not with respect to shaft of humerus.
- Usually the injury is closed (without wound).
- Brachial artery injury
- Anterior interosseous nerve – most commonly injured nerve (overall and in extension type) followed by median nerve and radial nerve
- Ulnar nerve – most likely to be injured in flexion type
- Volkmann’s ischemia & compartment syndrome
- Malunion leading to cubitus varus (gun stock deformity) is M/C complication.
- Cubitus valgus deformity [Tardy ulnar nerve palsy]
- Myositis ossificans
- Volkmann’s ischemic contracture