Supracondylar Humeral Fracture

Supracondylar humeral fractures represent 3% of all fractures in children and 85% of elbow fractures in children. They are generally caused by a fall on the outstretched hand (FOOSH), usually with hyperextension of the elbow. The male:female ratio is 9:1, with a bimodal age distribution: 2 to 8 and 11 to 15 years old.

Causes

Most often, a supracondylar fracture of the humerus is caused by a fall or jump. The children may stretch out his or her hand and the force from the impact may be enough to cause a break in the bone. But any trauma to the area, such as an injury from a car or two wheeler accident, may also be a cause of supracondylar humeral fracture.

Commonly, bone fractures are classified by the amount of displacement of the bone that occurs. Most supracondylar fractures of the humerus are displaced fractures, meaning one or both of the condyles have been moved from where they normally belong. Non-displaced fractures are less severe, and the bone does not separate into fragments. Displaced fractures means the bone has separated and needs to be rejoined.

Signs and Symptoms

• Tenderness at distal humerus and resistant to motion in all planes
• Neurologic deficit ++, most commonly anterior interosseous nerve

Treatment

Call the doctor as soon as possible. In the meantime follow directions for R.I.C.E.:

• Rest the injured area as much as possible.
• Ice the injury to reduce blood flow and limit swelling.
• Compress the injured joint according to your doctor’s instructions.
• Elevate the arm to help control swelling.

If the fracture is displaced, the bones need to be reduced - which just means moved back into position. In the case of a supracondylar fracture of the humerus, a pin will be needed. The pin is used to hold the bones in place while they heal.

Appropriate pain medication may be prescribed depending on your child's level of pain. Acetaminophen is often recommended for mild pain.

If there is no displacement of the bone or the fat pads, the most common form of treatment is to immobilize the arm. Most often a splint will be used and parents will need to check to make sure the child can move his or her fingers. The splint will probably stay on for about three weeks to give the bone time to heal.