Rosh Emergency Medicine Practice Test

For a comminuted, displaced supracondylar humerus fracture in an elderly woman, what is the most appropriate treatment?

1. Cast treatment without reduction

2. Closed reduction and percutaneous fixation

3. Open reduction and internal fixation

4. Total elbow arthroplasty

The correct answer is: Open reduction and internal fixation

In the case of a comminuted, displaced supracondylar humerus fracture in an elderly woman, open reduction and internal fixation is typically the most appropriate treatment option. This approach is warranted because the fracture is not only comminuted but also displaced, indicating a significant loss of bone integrity and stability that cannot be adequately managed with non-operative measures. Open reduction allows for direct visualization of the fracture, enabling the surgeon to properly realign the fragments and ensure anatomical restoration of the joint surface. Internal fixation provides the necessary stability to maintain alignment during the healing process, which is crucial in elderly patients who may have poorer healing capacity due to age-related factors. Other treatment options, such as a simple cast treatment without reduction, would be insufficient for a displaced fracture of this nature, as it would not address the alignment and stability of the fracture. Closed reduction and percutaneous fixation may be considered for certain types of fractures, but in the presence of significant comminution and displacement, open reduction provides better control and fixation. Total elbow arthroplasty is generally reserved for more complex cases, such as severe joint degeneration or irreparable fractures, rather than a straightforward management of a displaced fracture. Thus, open reduction and internal fixation stands out as the most