Understanding Supracondylar Humerus Fractures & Peptic Ulcers

Posted on Mar 9, 2025 in Biology

Supracondylar Fractures of the Humerus

A supracondylar fracture involves the lower end of the humerus, usually affecting the thin portion through the olecranon fossa, just above the fossa, or the metaphysis.

  • Most common elbow injuries in children.
  • Makes up approximately 60% of elbow injuries.
  • Becomes uncommon as age increases.

Fracture Complications

  • Compartment syndrome
  • Vascular injury/compromise
  • Loss of reduction/Malunion – cubitus varus
  • Loss of motion
  • Pin track infection
  • Neurovascular injury with pin placement

Treatment Options

  1. Closed reduction and percutaneous K-wire fixation
  2. Open reduction and K-wire fixation
  3. Continuous traction

Peptic Ulcers

Peptic ulcers are of two types:

  • Duodenal ulcer
  • Gastric ulcer

H. pylori is responsible for:

  • 90% of duodenal ulcer cases
  • 75% of gastric ulcer cases

The most common type of peptic ulcer is a duodenal ulcer, and the most common site is the first part of the duodenum.

Treatment for gastric ulcers depends on location/type, while treatment for duodenal ulcers depends on complications.

Classification of Gastric Ulcers (Modified Johnson’s Classification)

  • Type 1: Ulcer located at incisura angularis (most common)
  • Type 2: Two ulcers – one in the body of the stomach and one at the first part of the duodenum.
  • Type 3: AKA Prepyloric ulcer, located just before the pylorus.
  • Type 4: Ulcer located higher on the lesser curvature.
  • Type 5: NSAID-induced ulcers.

Management of Gastric Ulcers

  • Type I – Distal Gastrectomy
  • Type II & III – Truncal vagotomy + antrectomy
  • Type IV – Special surgeries (CSENDES, SHOEMAKER)
  • Type V – Stop NSAIDs

Treatment

Complications of Peptic Ulcers

  1. Intractability – not healing after medical management
  2. Bleeding – most common complication of peptic ulcer
  3. Perforation – most common complication of gastric ulcer
  4. Gastric outlet obstruction

POUCHET, KELLING MADLENER

HSV (Highly Selective Vagotomy) – Performed for intractable duodenal ulcers and chronic duodenal ulcers.

  • Ulcers located on the anterior wall of the duodenum – Perforate
  • Ulcers located on the posterior wall of the duodenum – Bleed

The most commonly involved artery in bleeding duodenal ulcers is the gastroduodenal artery.

  1. For Bleeding Duodenal Ulcer: Duodenotomy + Ligation of bleeding vessel + Truncal vagotomy (to prevent re-bleeding & recurrence due to high acid production) + Pyloroplasty (to prevent stricture formation)
  2. Modified GRAHAM’S REPAIR (AKA OMENTAL PATCH REPAIR): A vascularized pedicle of omentum is patched over the defect.

Posterior Ulcer, Anterior Ulcer

  1. For Gastric Outlet Obstruction (GOO): A rare complication of peptic ulcer.

The most common cause of GOO worldwide is CA stomach, and the most common site of obstruction in GOO is the first part of the duodenum.

Diagnosis

Saline load test:

Empty the stomach – Insert Ryle’s tube

↓

Instill 750 ml of saline & place patient in sitting position

after 30 min

Management

Initial management:

Nasogastric aspiration

↓

If residual saline

< 400 ml

↓

Normal

> 400 ml

↓

Gastric outlet obstruction

NPO for 48hrs

IV fluids (Fluid of choice – Normal Saline)

Most patients improve

For non-responding pts:

TOC – Truncal vagotomy + antrectomy

If antrectomy becomes difficult (due to extensive fibrosis and scarring)

↓

Alternative Treatment – Truncal vagotomy + Gastrojejunostomy