There is a predominance of males that is to say 101 over 34 in the females; the right side is the most affected.

The age varies from 20 to 60 years .Only 10 patients are more than 50 years old.

The mechanism is sometimes difficult to specify. The supracondylar fractures of the adult are specially caused by a constraint in flexing: direct shock on the pallet, shock on the flexing elbow.

The injured man presents a total impaired mobility of the elbow and holds his upper limb with the contralateral limb.

The inspection shows a significant and painful deformity, with an oedema and a haematoma. So, we need to search a cutaneous access, which is often posterior.

The palpation does not find the osseous reference marks, characteristic of the elbow. We must take the distal pulses, search a paralysis of the cubital, of the radial one and/or of the median nerve and to keep informed, if they are present, the patient and his family.

We need to search other lesions on the upper limb (wrist, shoulder, before arm).

The Radiography is systematic and is centred on both the full-face and profile elbow. It will include according to the clinical examination, radiographies of the supra and subjacent joints.

Ideally, radiography must be repeated at the surgical unit with accurate index on the limb in traction after having placed the anaesthesia.

In the event of compound fracture, a prophylactic antibiotic therapy must be carried out and tetanus vaccination must be checked and possibly repeated.

The lesions are usually reported to the diagram of the SOFCOT round table in 1979 [ 1 ]: supra condylar, supra and inter condylar and fragmented joint fractures,.

They have the best forecast.

• Supracondylar fractures account for 26 cases (19,25%).

• Extra-joint fragmented fractures are relatively rare in the adult. The characteristic feature, which is sagittal, separates the medial or side extensor condyle of the humerus from the rest of the metaphysis. The degree of displacement is much variable under the influence of the muscles which are inserted inside.

• Extra and intercondylar Fractures

They have the majority with 75 cases (55,5%).

Diaphyseoepiphyseal fractures, which extra condylar and spiroid characteristic feature wind up in the middle of the diaphysis.

• Joint fragments are much moved and sometimes comminuted.

• Diacolumnar fractures: complex, they include three main characteristic features: A feature coarsely horizontal on a column, insulating more often a large fragment of the condylar extensor of humerus;

• An almost frontal feature separating joint surfaces;

And a sagittal feature splitting again the previous one on the level of the trochlea.

They are recognizable by the stump of column which has remained intact.

They include the unicondylar fractures in 12 cases (8,8%), with the sagittal feature, and purely joint fractures, whose feature, is primarily frontal.

• Unicondylar fractures are the least rare: side condyle in 10 cases (7,4%) or medial in 2 cases (1,4%). The fragment of side condyle separated from the metaphysis includes the condyle, side extensor condyle of humerus and the external cheek of the trochlea. Association is frequent with a radial head fracture in 2 cases (1,4%) and the olecranium in 2 (1,4%) cases.

• Pure joint fractures include 4 (2,9%) cases. The feature is practically frontal, discreetly oblique at the bottom and behind. It separates a variable fragment with joint surface, which moves ahead and in top, giving the full face an aspect of double contour. According to the size of the fragment, we distinguish three types among them:

• Capitellum fracture or Hahn-Steinthal type I in 1 case(0,7%) or eminentia capitata fracture is the smallest one;

• Hahn-Steinthal fracture or type II in 1 case( 0,7%), takes not only the condyle, but also the conoid area and the trochlea external cheek;

Kocher diacondylar fracture in 1 case( 0,7%)

Orthopedic treatment

Immobilization in plaster

Immediate rehabilitation/physical therapy

Surgical reduction and osteosynthesis

The access way

In the fragmented fractures, screwing can be recommended in some cases, the ablation of a fragment can be made when this one cannot be screwed.

Figure 1

Photography 1 : fracture supra and intercondylar profile view of palett associated to a fracture of the radius neck

Figure 2

Photography II : Osteosynthesis by Lecestre plate

We counted 25 cases (18,5%) of stiffness which were taken again surgically by arthrolysis. The causes are related to the local conditions.

All joint or per joint elements can contribute to decrease mobility when they are impaired.

2 nervous complications were noted, it was about regressive paralysis of the ulnar nerve and medial one.

There were in 3 cases (2,2%) related to reduction defects or secondary moving.

Figure 4

Photography 5 : Metaphysialdiaphysial epiphysial

Figure 5

Photography 6: Second moving with tendency of vicious case

The same series give a report on two peaks/pick of frequency. The one, including between 20 and 30 years, is made of a majority of men and corresponds to violent traumatisms: public highway accidents (23 to 27 %) or falls from a high place, sometimes with major crash (traffic elbow). The associate lesions (cutaneous opening, poly-traumatism) are particularly frequent in this case. The other concerns the old subject between 60 and 80 years, with a female prevalence.

The generally found causal traumatism is the simple fall (Decoulx 44 % [3]), Lecestre 48 % [4], Folschveiller 58 % [5], Claisse 66 % [6], which can involve significant damage.

The type of fracture identical to that is described in literature 15 to 20 % of the distal fractures of the humerus in the adult. The feature is generally oblique:

• in the frontal plan, finishing on the level of a column (side);

• in the sagittal plan, bellow and behind.

• It can be transverse, spiroid, with third fragment or comminuted.

The non moved forms are frequent [4].The height of the feature is extremely variable, interesting the small cavities or placed largely above the small cavities. In the majority of the series (25 to 55 %). the lesion interests both columns, associating a feature supra condylar with adjustable height and an intercondylar feature which detach usually the trochlea external cheek. The first classifications were testing the number and the fragments moving, the feature type, in T-shaped, V-shaped or Y-shaped. But the complex fractures often are not subject to any description. The main prognosis factor is the degree of communition supra condylar and above all articular. Lecestre and Dupont [4] individualized two rare forms but which are therapeutic sources of complications: the diaphyseoepiphyseal and diacolumnar fractures.

- the regulated ablation of the capitellum was recommended by many authors even in the event of broad fragment, because of the simplicity of the aftermath of surgery and the difficulties related to the osteosynthesis. This exeresis avoids the possible avascular necrosis of the fragment which is seldom observed. Sometimes good [7 ], the functional result is generally poor medium-term, especially in the event of delayed excision. The risk of after effects instability of the elbow in valgus is largely raised by the resection associated with the radial head, and especially the existence of a lesion of the LLI. The resection at first sight should thus be reserved for small size and/or comminuted fragments.

the open hearth reduction gives the best results, on condition that it is anatomical.

The osteosynthesis is less stable by pins than by a screwing in recall by the posterior face deprived of cartilage. A technique of per cutaneous reduction without synthesis was published [8].

The frequency of the nervous complications after treatment is variously assessed according to the authors and surgical techniques’: to 7 % according to Fontanesi [ 9 ], 12 % according to Burri [ 10 ], 15 % according to Kipfer [ 11 ] and Jupiter [ 12 ], 16 % at the time of SOFCOT round table [ 13 ], 27 % according to Lecestre and Lortat-Jacob [ 4 ], 33 % f according to Claisse [ 6 ], up to 54 % according to Langlais [ 13 ] after assembly in triangulation.

It is generally injured by far (49 cases out of 60 at the time of the SOFCOT round table).

Two elements can support the appearance of an ulnar paralysis:

the too broad dissection of the nerve, must be protected and handled carefully to the maximum;

Its attack is rarer in post operative. Lecestre [13] notes nevertheless 11 cases among them over 388 operated cases (2, 8 %). 10 was not re-operated and end in 9 healings, a case treated by neurolysis.

Peri joint ossifications are also a frequent source of stiffness (21 % of the cases according to Fontanesi [ 9 ], 20 % according to Claisse [ 6 ]):

whether small, located in the thickness of the capsule or the small cavities, forming

a stop;

or more significant, dense and well limited, located ahead, in the muscle brachial. The indication of an arthrolysis of the elbow will be decided only after healing of the fracture, for significant stiffness and at the subjects whose behavior enables to hope for an effective participation in rehabilitation. A normal joint line space or close to the normal is essential, which finally limits this technique with the pallet traumatisms which are not accompanied by too significant osseous rehandlings. The various authors preferred largely the use of a double side track. It gives a good result in 1 case out of 2, approximately, according to Lecestre [13].