Makindo Medical Notes

Related Subjects: |Fractured Neck of Femur |Fractured Shaft Femur |Supracondylar Femur Fractures |Supracondylar Humerus Fractures |Femoral fractures |Fractured Tibia and Fibula

Supracondylar Humerus Fractures 💪🦴 are the most common elbow fractures in children (esp. boys, ages 5–10). Mechanism is usually a fall onto an outstretched hand (FOOSH) with the elbow in extension. These fractures are an orthopaedic emergency 🚨 due to risk of vascular and nerve injury.

📖 About

• Fracture just above the distal humerus condyles.
• Most common paediatric elbow fracture.
• Extension-type (>95%) from FOOSH; flexion-type rare.

⚙️ Aetiology

• Simple falls from low height (playground, running).
• FOOSH with hyperextension at the elbow.
• Less commonly, direct trauma to the flexed elbow.

🩺 Clinical Features

• Severe elbow pain + swelling.
• Refusal to move elbow; child supports arm with opposite hand.
• Examine neurovascular status:
  • Brachial artery injury → absent radial pulse 🚨
  • Median nerve palsy → weak thumb flexion, sensory loss index finger
  • Anterior interosseous nerve (branch of median) → cannot make “OK” sign
  • Radial nerve → weak wrist extension
  • Ulnar nerve → weak finger ab/adduction

⚠️ Complications

• Malunion with varus deformity (“gunstock deformity”).
• Brachial artery injury → limb ischaemia.
• Volar compartment syndrome → may progress to Volkmann’s ischaemic contracture.
• Nerve injuries (median > anterior interosseous > radial > ulnar).
• Stiffness, myositis ossificans (rare).

🧪 Investigations

• X-rays: AP & lateral of elbow/humerus.
• Signs: fat pad sign (anterior/posterior) may indicate occult fracture.
• Repeat X-ray at 7–10 days if high suspicion and initial films equivocal.
• Assess Baumann’s angle (for displacement/angulation).

💊 Management (Gartland Classification)

• Type I: Undisplaced → immobilise in above-elbow cast/splint for ~3 weeks.
• Type II: Displaced with intact posterior cortex → Closed reduction + immobilisation (elbow <90° flexion). ⚠️ High risk of stiffness/contracture → percutaneous K-wire fixation preferred.
• Type III: Complete displacement → Closed reduction + percutaneous pinning (CRPP). May require open reduction if unstable or neurovascular compromise.
• Open fractures / vascular injury: urgent surgical exploration.

📌 OSCE / Exam Pearls

• Most common paediatric elbow fracture = supracondylar humerus.
• Always document pulses + 3 nerves (median, radial, ulnar) before and after reduction.
• Extension-type is far more common than flexion-type.
• Do NOT immobilise in >90° flexion → increases risk of compartment syndrome.
• Persistent absent radial pulse after reduction = explore brachial artery.

📚 References

• Rockwood & Wilkins’ Fractures in Children, 9th ed.
• BOAST Guidelines: Management of Supracondylar Fractures in Children.
• Gartland JJ. Management of supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1959.