UMEM Educational Pearls

Category: Pediatrics

Title: Supracondylar fractures in children (submitted by Mike Santiago, MD)

Keywords: orthopedics, fracture, reduction, elbow (PubMed Search)

Posted: 6/15/2012 by Mimi Lu, MD
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Definition: Fracture of the humerus just proximal to the epicondyles.

-Classification of fracture based on mechanism:
  • Extension type (majority >80%; distal fx segment displaced posteriorly)
  • Flexion type (distal fx segment displaced anteriorly)
-Assessment should be made for neurovascular injuries.
  • Any diminished pulsations or capillary refill should cause concern for vascular compromise (arterial compression, tear, or compartment syndrome).
  • Place a continuous pulse oximetry probe on the affected hand to monitor bloodflow.
  • The radial, median, or ulnar nerves may be affected and should be assessed.
-Look for accompanying fractures of the forearm and wrist and xray those areas if suspected.
-Nondisplaced fractures may follow up with orthopedics within 1 week after posterior long arm splinting (elbow at 90 degrees & forearm in neutral position)
-Displaced fractures require prompt pediatric orthopedic consultation for closed reduction in OR vs operative repair.
-Obtain emergent orthopedic consultation for compartment syndrome, neurovascular compromise, or open fracture.
-Partial reductions in ED likely just increase soft tissue swelling and delay definitive reduction and should be reserved for rare cases of vascular compromise.

Wheeless, CR.  Pediatric Supracondylar Fractures of the Humerus.  Wheeless’ Textbook of Orthopedics.  [Accessed online 4/22/12.]
Ryan, LM.  Evaluation and management of supracondylar fractures in children.  UpToDate.  [Accessed 4/22/2012].