Here’s a taste for the fascinating things we’ve been learning in MSK!
Have a look at this x-ray. Try to determine which part of the body you are looking at, and which bone is broken:
Well, the answer was in the title of this post 
, but you may not have known what it meant. This x-ray shows a supra-condylar humeral fracture, or in other words a break to the arm bone, just above the elbow. They are common in children who have fallen on an outstretched arm.
Note a few features of this x-ray:
- It’s unclear from the x-ray alone whether the skin has been broken. The fragment of humerus displaced anteriorly (upwards) appears as if it may have protruded the skin, making this an “open” fracture.
- The elbow joint itself may still be intact – the distal capitulum and trochlea (end parts!) of the humerus are still aligned with the radius and ulna below
- The deformity would certainly be apparent on physical exam! Look at the contours of the arm – seeing an arm with this deformity would suggest a supra-condylar humeral fracture, even before an x-ray is taken.
Since this fracture was actually closed (not open), it was fixed by “closed reduction” and percutaneous pinning. Essentially that would involve traction (pulling on the arm), applying a force on the distal fragment to re-align the pieces, and then flexing the elbow to maintain alignment. Of course this would be done under anaesthetic! The reduction and alignment is then held in place with pins applied through the skin:
