Fracture - Supracondylar Humerus in children
A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow.
Supracondylar fractures are the most common type of upper arm injury in children.
They are frequently caused by a fall on an outstretched elbow or a direct blow to the elbow. These fractures are relatively rare in adults.
Surgery isn’t always required. Sometimes a hard cast may be enough to promote healing.
Complications of supracondylar fracture can include injury to nerves and blood vessels, or crooked healing (malunion).
Symptoms of a supracondylar fracture
Symptoms of supracondylar fracture include:
Risk factors for this type of fracture
Supracondylar fractures are most common in children under 7 years old, but they can affect older children as well. They are also the most commonTrusted Source type of fractures requiring surgery in children.
Supracondylar fractures were once thought to be more common in boys. But recent studiesTrusted Source show that girls are just as likely as boys to have this type of fracture.
The injury is more likely to occur during summer months.
Diagnosing a supracondylar fracture
If a physical examination shows likelihood of a fracture, the doctor will use X-rays to determine where the break occurred, and to distinguish a supracondylar fracture from other possible types of injuries.
If the doctor identifies a fracture, they will classify it by type using the Gartland system. The Gartland system was developed by Dr. J.J. Gartland in 1959.
If you or your child has an extension fracture, that means the humerus has been pushed backward from the elbow joint. These make up about 95 percent of supracondylar fractures in children.
If you or your child is diagnosed with a flexion injury, that means that the injury has been caused by a rotation of the elbow. This type of injury is less common.
Extension fractures are further classified into three main types depending on how much the upper arm bone (humerus) has been displaced:
type 1: humerus not displaced
type 2: humerus moderately displaced
type 3: humerus severely displaced
In very young children, the bones may not be sufficiently hardened to show up well on an X-ray. Your doctor may also request an X-ray of the uninjured arm to make a comparison.
The doctor will also look for:
tenderness around the elbow
bruising or swelling
limitation of movement
possibility of damage to nerves and blood vessels
restriction of blood flow indicated by a change in color of the hand
possibility of more than one fracture around the elbow
injury to the bones of the lower arm
Treating this fracture
If you suspect you or your child has a supracondylar or other type of fracture, see your doctor or go to the emergency room as soon as possible.
Surgery is usually not necessary if the fracture is a type 1 or a milder type 2, and if there are no complications.
A cast or a splint can be used to immobilize the joint and allow the natural healing process to begin. Sometimes a splint is used first to allow the swelling to go down, followed by a full cast.
It may be necessary for the doctor to set the bones back into place before applying the splint or cast. If that’s the case, they will give you or your child some form of sedation or anesthesia. This nonsurgical procedure is called a closed reduction.
More severe fractures
Severe injuries may require surgery. The two main types of surgery are:
Closed reduction with percutaneous pinning. Along with resetting of the bones as described above, your doctor will insert pins through the skin to rejoin the fractured parts of the bone. A splint is applied for the first week and then replaced by a cast. This is the most commonTrusted Source form of surgery.
Open reduction with internal fixation. If the displacement is more severe or there is damage to the nerves or blood vessels, open surgery will likely be needed.
Open reduction is required only occasionally. Even the more severe type 3 injuries can often be treated by closed reduction and percutaneous pinning.