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SUPRACONDYLAR-Y FRACTURES OF THE HUMERUS

1953; British Editorial Society of Bone & Joint Surgery; Volume: 35-B; Issue: 3 Linguagem: Inglês

10.1302/0301-620x.35b3.381

2044-5377

E. Mervyn Evans,

Shoulder and Clavicle Injuries

indication of the poor quality of the results often obtained. In the words of Watson-Jones (1943) “ no injury of the elbow gives rise to more difficulty in treatment. It may be impossible to secure perfect replacement by manipulation and traction. Operative reduction is very difficult ; it involves a free dissection of the triceps and capsule of the joint, and there is usually no natural stability of the fragments, so that reduction can only be maintained by screws and plates. Adhesion of the triceps, contraction of the capsule, avascular necrosis contribute to dense adhesion formation and permanent stiffness. Despite the perfect anatomical reposition which may have been secured the final range of movement is usually less satisfactory than after manipulation, even when manipulative reduction has been less accurate. Operative reduction is not justified by the results. Two alternatives are available: 1) To secure the best possible position by manipulation and traction. 2) In grossly comminuted fractures with irreparable joint injury to perform an immediate arthroplasty. ‘ ‘ Watson-Jones goes on to describe manipulative reduction followed by plaster immobilisation, a method which the author has found to be followed by considerable joint stiffness. Perhaps more commonly used is the so-called ‘ ‘ bag of bones ‘ ‘ technique, whereby the arm is supported in a collar and cuff, and immediate active movements practised. This is certainly a valuable method in the elderly, as a considerable range of movement may be obtained. The joint, however, is apt to be unstable and much power is lost, so that it cannot be said to lead to a satisfactory result in the younger patient. Late traumatic arthritis must not be forgotten; the elbow is a non-weight-bearing joint, but gross disorganisation of the joint surfaces does lead to arthritis in time. If operative reduction is advocated the Campbell posterior approach is most favoured, with accurate fixation of all the main fragments by plates or multiple screws-a procedure calculated to lead to considerable limitation of movement. Surely a simpler approach to the treatment of this difficult injury is needed. The ordinary supracondylar fracture of the humerus is not difficult, and the Y-fracture can be converted into a supracondylar by the accurate reduction and fixation of the condylar fragments. Furthermore, the alignment of the intraarticular surfaces is thus restored, and good lasting function may be expected, provided the operative approach has done no harm. Any residual displacement between the two fixed condylar fragments and the shaft may be corrected by subsequent manipulation, and, even if it persists, will not have any great deleterious effect upon the ultimate function.