Supracondylar Fracture: Diagnosis and Treatment

Supracondylar fracture is a fracture of the lower end of the humerus bone just above the elbow joint. It is a very common fracture in children. It is caused by a fall on the out stretched hand with a hyper-extension force acting on the elbow.

Before reading further please see the Elbow Joint Anatomy to get a better understanding (skip if you have already done so).

This fracture is

• most common between the age of 5 to 9 years
• two times more common in males
• right to left side ratio is 2:3

Classification is into three types depending in the degree of separation of fracture fragments.

• Type 1 are undisplaced or minimally displaced fractures (fracture is hairline)
• Type 2 are partially displaced (fragments are nearly aligned, some bony contact is present)
• Type 3 are completely displaced (fracture fragments are far apart from each other)

A x ray of a type 2 supracondylar fracture.

A x ray of a type 3 fracture.

Symptoms include

• pain
• swelling
• deformity at the elbow region

In Type 1 fractures deformity may not be present. There may only be mild swelling along with pain. The child will avoid using the elbow. Tenderness can be elicited at the fracture site. Due to the presence of mild symptoms diagnosis may be delayed as the parents unsuspecting a fracture may report late.

In displaced fractures the deformity is obvious even to the inexperienced eye.

Important nerves and blood vessels are present near the elbow joint that may be injured by a Type 3 displaced fracture.

Diagnosis is by X ray of the elbow joint. X ray will show the fracture and will help in classification.

Treatment of supracondylar fracture is based on the classification

• Type 1 fractures are treated with simple immobilization in a plaster cast without any manipulation.
• Type 2 fractures are treated by manipulation followed by immobilization in a plaster cast. The cast is kept for three weeks.
• Type 3 fractures require operative treatment. An attempt is made to reduce the fracture without exposing the bone fragments through an incision. If successful then the fracture is held in place by 1.5 or 2mm stainless steel wires called K wires.

  If this is unsuccessful then the fracture is exposed by a incision and the bone fragments are aligned under vision. They are then held in place by K wires.

A pre-operative and post-operative x ray photo of a type 3 fracture. You can see the K-wires in the postoperative x ray photo.

Complications include

• vascular injury
• nerve injury
• compartment-syndrome
• malunion (fracture unites in a wrong position called gun stock deformity)
• loss of movement (I had one patient who had sustained a type 1 fracture and the fracture fragments were impacted into each other. She lost 20 degrees of elbow extension.)

This is a photo of a 13 year girl with a gun stock deformity in her left elbow along with the x ray below. The deformity was corrected surgically. During surgery the technique of focal dome osteotomy was used.

Frequently Asked Questions

When is the plaster cast removed?

Usually by the end of three weeks enough callus (soft bone that unites the fracture) has formed to allow restricted activity. This is the time when most casts are removed.

How long does it take to regain complete movement of the elbow joint?

It can take any where between 2 to 3 months to regain complete movement of the elbow joint.

Is it a must to operate in type 3 fractures?

If surgery is not done in type 3 fractures the fracture will still unite but in a wrong position. The child will probably develop a gun stock deformity. In spite of the deformity he may regain full function of the limb. He may have no trouble at all. But he may be declared physically unfit for military service. So the best is to have a normal looking and normal functioning limb.

Can a gun stock deformity be corrected surgically?

Yes it can. But it is more difficult than treating a displaced type 3 supracondylar fracture.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 31st August 2010.

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Other causes of elbow pain...

Elbow Dislocation

Pulled Elbow

Olecranon Fracture

Tennis Elbow

Golfers Elbow

Olecranon Bursitis

Little League Elbow

Radial Head Fracture

Lateral Condyle Fracture

Elbow Fracture

Elbow Joint Anatomy

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