“Gun stock” deformity is seen in
Correct Answer: Supracondylar fracture of humerus
Description: Ans. b (Supracondylar fracture of humerus) (Ref. Maheshwari orthopedics 3rd ed., 85)SUPRACONDYLAR FRACTURES OF THE HUMERUS# This is the most common fracture around the elbow in children.# The injury is usually due to a fall on the outstretched hand with an extended elbow and this results in a hyperextension injury with posterior angulation, with or without posterior displacement of the distal fracture.# Radiological diagnosis :- Displaced anterior fat pad is a radiographic sign of supracondylar fracture, which may be complicated by Volkmann's ischemic contracture.- Capitellum angle, Anterior humeral line, and anterior coronoid line drawn on true lateral radiographs and Bauman's angle on a true anteroposterior view, can be helpful in assessment of the fracture.- Bauman's angle is the angle formed between the growth plate of the capitellum and a line perpendicular to the humeral shaft. The normal angle is approx 30deg and can be used to assess the adequacy of reduction of a fracture.# Classification:- Extension types and- Flexion types (much less common).# Extension types are further subdivided:- Type 1. The fractures are undisplaced but the radiographic lines should be carefully assessed to confirm this.- Type 2. The fractures are angulated posteriorly, but the posterior periosteum remains intact, and prevent displacement and overlap of the fracture fragments.- Type 3. The fractures are completely displaced with shortening and overlap of the fragments.# Treatment- Type 1 fractures can be treated conservatively in a collar and cuff, with 90deg of flexion at the elbow.- Type 2 fractures should be treated by closed reduction if the position is unacceptable. Bauman's angle should be corrected if there is any varus or valgus deformity as this will not remodel.- Type 3 fractures usually require reduction but this is often difficult and the fracture site is commonly unstable after reduction, with a significant rotational element. Under GA traction is applied to the supinated forearm.- With supracondylar fractures, the brachial artery can be compromised, resulting in the loss of the radial artery pulse; therefore, the radial artery pulse must be assessed when the fracture is reduced.# Complications of supracondylar 1. vascular injury2. Neurological injury3. Volkmann's Ischemic contracture4. Malunion ("Gun-stock" deformity)5. Valgus deformity6. NonunionMCQsAns.1Most common type of elbow injury in children and adolescentsSUPRACONDYLAR FRACTURE OF HUMERUS2Most common cause of supracondylar fracture of humerusHYPEREXTENSION INJURY3Most common type of supracondylar fracture of humerusEXTENSION TYPE4Most common type of distal fragment displacement in supracondylar fracture of humerusPOSTERIOR (DORSAL/BACKWARD) SHIFT AND TILT5Most common type of distal fragment displacement in flexion type of supracondylar fracture of humerusANTERIOR (DORSAL/BACKWARD) SHIFT AND ANGULATION TILT6Most common complication of supracondylar fracture of humerusMALUNION7Least common complication of supracondylar fracture of humerusNONUNION8Most common deformityGUN-STOCK DEFORMITY (CUBITUS VARUS)9Most common nerve injuredANTERIOR INTEROSSEOUS NERVE10Tardy ulnar nerve palsyCUBITUS VALGUS (LATERAL CONDYLAR FRACTURE)11Most common cause of VICFRACTURE SUPRACONDYLAR HUMERUS12Most common cause of Volkman's ischemia and compartment syndrome in childrenFRACTURE SUPRACONDYLAR HUMERUS13Most common site of myositis ossificansAROUND ELBOW14Most common muscle involved in VICFLEXOR DIGITORUM PROFUNDUS15First sign/ Most common sign of VICPAIN16Most common nerve involved in VICMEDIAN NERVE17Most Common Nerve involved in anterior shoulder dislocationAXILLARY (CIRCUMFLEX HUMERAL) NERVE18Most Common Nerve involved in surgical neck humerus fractureAXILLARY NERVE19Most Common Nerve involved in fracture shaft of HumerusRADIAL NERVE20Most Common Nerve involved in fracture medial condyle of humerusULNAR NERVE21Most Common Nerve involved in Monteggia fracture-dislocationPOSTERIOR INTEROSSEOUS NERVE22Most Common Nerve involved in scapholunate dislocationMEDIAN NERVE23Most Common Nerve in Hip dislocationSCIATIC NERVE24Most Common Nerve in Knee dislocationPERONEAL NERVE25Best prognosis after nerve repairRADIAL NERVE26Worst prognosis after nerve repairSCIATIC AND FEMORAL NERVE
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