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Potentially life-threatening emergency
Pediatric supracondylar fracture of humerus
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Pediatric supracondylar fracture of humerus

Contributors: Linda Zhang MD, Surya Mundluru MD
Other Resources UpToDate PubMed

Synopsis

Causes / typical injury mechanism: Supracondylar humerus fractures are typically caused by a fall onto an outstretched arm, causing a hyperextension load on the elbow. A more uncommon mechanism of injury is a fall directly onto the olecranon of a flexed elbow.

Classic history and presentation: The classic presentation is a child who sustains a fall and trauma to the extremity, with immediate onset of pain and unwillingness to move the elbow.

Prevalence: This is the most common fracture of the elbow in children.
  • Age – Seen most in children aged 3-8 years.
  • Sex / gender – Occurs with equal prevalence in both sexes.
Pathophysiology: The olecranon hyperextends into the olecranon fossa, acting as a fulcrum and leading to anterior tension force and failure of the distal humerus anteriorly.

Grade / classification system: Modified Gartland classification of extension-type fractures
  • Type I – Nondisplaced
  • Type II – Displaced with intact posterior hinge
  • Type III – Completely displaced with no intact cortices
  • Type IV – Multidirectional instability (determined by examination under anesthesia)
Classification of vascular status
  • Hand well perfused (warm, pink), radial pulse present
  • Hand well perfused (warm, pink), radial pulse absent
  • Hand poorly perfused (cool, blue, blanched), radial pulse absent

Codes

ICD10CM:
S42.416A – Nondisplaced simple supracondylar fracture without intercondylar fracture of unspecified humerus, initial encounter for closed fracture

SNOMEDCT:
263193000 – Supracondylar fracture of humerus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Pitfalls:
  • Look for associated fractures in the ipsilateral extremity.
  • Do not miss a vascular injury. If the hand is noted to be pulseless, immediate orthopedic referral is recommended. It is not advised to perform ED-based acute reductions as the neurovascular bundle can be entrapped in the fracture, potentially leading to transection or further injury.
  • If the hand remains pulseless and poorly perfused after operative reduction, immediate exploration of the brachial artery is indicated as 50% of patients will require vascular surgery and 25% may develop compartment syndrome.
  • Do not miss compartment syndrome. Look for tenseness of the volar compartment, swelling at the elbow, and pain with passive finger extension and flexion. Remember the 3 As of pediatric compartment syndrome: anxiety, agitation, and analgesic requirement.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:11/29/2021
Last Updated:11/29/2021
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Potentially life-threatening emergency
Pediatric supracondylar fracture of humerus
Copyright © 2022 VisualDx®. All rights reserved.