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How to differentiate type IV supracondylar fracture from flexion type?

Asked by Hameed 

It is likely that substantial overlap exists between type-IV and flexion-type fractures. However, not all type-IV fractures are flexion-type variants and not all flexion-type fractures are multidirectionally unstable.

While the distal fragment is angulated in flexion (displaced anteriorly), in 30% cases of type IV extension fractures, there might be flexion angulation with displacement of distal fragment anteriorly.

One clue might be that, in extension type, fracture line runs upwards and backwards. And in flexion type, it runs downwards and backwards.

  1. The reduction and fixation methods for both are however similar.

  2. How do you fix type IV supracondylar fractures?

    1. We sometimes use transolecranon pin to hinge the fracture fragment and then correct tilt and rotation before fixing with the K-wires.