Supracondylar Humerus Fracture in Children: Symptoms, Classification, Treatment and Complications
A supracondylar humerus fracture is a fracture occurring just above the elbow joint in the distal humerus. It is the most common elbow fracture in children, typically affecting children between 5 to 7 years of age. Early diagnosis and proper treatment are important because this injury can be associated with neurovascular complications.
What Causes Supracondylar Humerus Fracture in Children?
The most common mechanism is a fall on an outstretched hand, commonly called FOOSH, with the elbow extended.
Types:
* Extension type fracture accounts for about 95 to 98 percent of cases
* Flexion type fracture is less common and occurs after a fall on a flexed elbow
Anatomy Involved
The fracture occurs through the weak supracondylar region of the distal humerus.
Nearby important structures include:
* Brachial artery
* Median nerve
* Anterior interosseous nerve or AIN
* Radial nerve
* Ulnar nerve
These structures should always be assessed during examination.
Gartland Classification of Supracondylar Humerus Fracture
Type I
Undisplaced fracture
Type II
Displaced fracture with intact posterior cortex
Type IIA
Angulation only
Type IIB
Angulation with rotational deformity
Type III
Completely displaced fracture
Type IV
Multidirectional instability due to complete periosteal disruption
Symptoms of Supracondylar Fracture in Children
Common symptoms include:
* Severe elbow pain
* Swelling around the elbow
* Inability to move the arm
* Visible deformity
* Tenderness over distal humerus
* Child refusing to use the affected limb
Some children may present with an S shaped deformity.
Clinical Examination
Inspection
* Swelling
* Deformity
* Skin puckering
* Bruising
Palpation
* Tenderness
* Crepitus, but avoid repeated manipulation
Neurovascular Examination
Always assess:
Vascular
* Radial pulse
* Capillary refill
Nerve examination
Median nerve and AIN
Ask the child to make an OK sign
Radial nerve
Check wrist extension
Ulnar nerve
Check finger abduction
X ray Findings in Supracondylar Humerus Fracture
Anteroposterior and lateral elbow X rays are essential.
Important radiological signs:
Anterior Humeral Line
Normally passes through the middle third of the capitellum.
Baumann Angle
Helps assess coronal alignment.
Fat Pad Sign
Posterior fat pad sign may indicate an occult fracture.
Treatment of Supracondylar Humerus Fracture
Treatment depends on fracture type.
Type I
* Above elbow slab or cast
* Elbow flexed approximately 90 degrees
Type II
* Closed reduction with casting
* May require percutaneous pinning if unstable
Type III and Type IV
* Closed reduction and percutaneous K wire fixation
* Open reduction if required
Complications of Supracondylar Humerus Fracture
Early Complications
* Brachial artery injury
* Nerve injury
* Compartment syndrome
* Volkmann ischemic contracture
Late Complications
* Cubitus varus also called gunstock deformity
* Elbow stiffness
* Cubitus valgus
* Myositis ossificans
Key Points
* Most common elbow fracture in children
* Peak age is 5 to 7 years
* Extension type is the most common
* Most common late complication is cubitus varus
* Most feared complication is Volkmann ischemic contracture
* Displaced fractures are commonly treated with closed reduction and percutaneous pinning using K wires
A supracondylar humerus fracture is a fracture occurring just above the elbow joint in the distal humerus. It is the most common elbow fracture in children, typically affecting children between 5 to 7 years of age. Early diagnosis and proper treatment are important because this injury can be associated with neurovascular complications.
What Causes Supracondylar Humerus Fracture in Children?
The most common mechanism is a fall on an outstretched hand, commonly called FOOSH, with the elbow extended.
Types:
* Extension type fracture accounts for about 95 to 98 percent of cases
* Flexion type fracture is less common and occurs after a fall on a flexed elbow
Anatomy Involved
The fracture occurs through the weak supracondylar region of the distal humerus.
Nearby important structures include:
* Brachial artery
* Median nerve
* Anterior interosseous nerve or AIN
* Radial nerve
* Ulnar nerve
These structures should always be assessed during examination.
Gartland Classification of Supracondylar Humerus Fracture
Type I
Undisplaced fracture
Type II
Displaced fracture with intact posterior cortex
Type IIA
Angulation only
Type IIB
Angulation with rotational deformity
Type III
Completely displaced fracture
Type IV
Multidirectional instability due to complete periosteal disruption
Symptoms of Supracondylar Fracture in Children
Common symptoms include:
* Severe elbow pain
* Swelling around the elbow
* Inability to move the arm
* Visible deformity
* Tenderness over distal humerus
* Child refusing to use the affected limb
Some children may present with an S shaped deformity.
Clinical Examination
Inspection
* Swelling
* Deformity
* Skin puckering
* Bruising
Palpation
* Tenderness
* Crepitus, but avoid repeated manipulation
Neurovascular Examination
Always assess:
Vascular
* Radial pulse
* Capillary refill
Nerve examination
Median nerve and AIN
Ask the child to make an OK sign
Radial nerve
Check wrist extension
Ulnar nerve
Check finger abduction
X ray Findings in Supracondylar Humerus Fracture
Anteroposterior and lateral elbow X rays are essential.
Important radiological signs:
Anterior Humeral Line
Normally passes through the middle third of the capitellum.
Baumann Angle
Helps assess coronal alignment.
Fat Pad Sign
Posterior fat pad sign may indicate an occult fracture.
Treatment of Supracondylar Humerus Fracture
Treatment depends on fracture type.
Type I
* Above elbow slab or cast
* Elbow flexed approximately 90 degrees
Type II
* Closed reduction with casting
* May require percutaneous pinning if unstable
Type III and Type IV
* Closed reduction and percutaneous K wire fixation
* Open reduction if required
Complications of Supracondylar Humerus Fracture
Early Complications
* Brachial artery injury
* Nerve injury
* Compartment syndrome
* Volkmann ischemic contracture
Late Complications
* Cubitus varus also called gunstock deformity
* Elbow stiffness
* Cubitus valgus
* Myositis ossificans
Key Points
* Most common elbow fracture in children
* Peak age is 5 to 7 years
* Extension type is the most common
* Most common late complication is cubitus varus
* Most feared complication is Volkmann ischemic contracture
* Displaced fractures are commonly treated with closed reduction and percutaneous pinning using K wires
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