II. Epidemiology

  1. Most common elbow Fractures in Children
  2. Age of onset ranges between 2 and 12 years of age (peaks between 5 and 8 years of age)
  3. Gender: Twice as common in boys

III. Definition

  1. Distal humerus Fracture above the epicondyles and above the physis

IV. Pathophysiology

  1. Supracondylar region of the Humerus is the weakest part of the elbow (Humerus flattens, and widens)

V. Imaging

  1. See Elbow XRay
  2. Posterior fat pad sign
    1. Always abnormal
    2. May be only finding in a Type 1 supracondylar Fracture
  3. Anterior humeral line
    1. Should normally pass through middle third of capitellum
    2. Displaced in Type 2 and Type 3 Fractures
  4. Extension Fracture (most common)
    1. Distal fragment displaced posteriorly

VI. Classification

  1. Type 1: Non-displaced or minimally displaced
  2. Type 2: Distal fragment displaced and intact posterior cortex
  3. Type 3: Displaced and no contact between Fracture fragments

VII. Management

  1. Orthopedic referral in all cases
  2. Type 1 Fracture
    1. Splint initially
      1. Long Arm Splint or Double Sugar-Tong Splint
    2. Cast
      1. Longarm cast with Forearm in neutral rotation and elbow at 90 degrees
      2. Cast for 3 weeks followed by XRay to demonstrate supracondylar callus
      3. Active range of motion starts after three weeks of Casting
  3. Type 2 Fracture
    1. Splint as above and follow-up with orthopedics to determine whether Casting will be sufficient
    2. Open reduction and internal fixation in some cases
  4. Type 3 Fracture
    1. Open reduction and internal fixation in all cases

VIII. Complications: Type 3 Fracture

  1. Malunion or poor healing
    1. Secondary to severe displacement, incomplete reduction, or significant Soft Tissue Injury
    2. Gun stock deformity
      1. Elbow varus angulation and loss of full elbow extension
  2. Compartment Syndrome
  3. Nerve injury (transient Neuropraxia typically resolves in weeks after injury)
    1. Median Nerve injury
    2. Radial Nerve injury
    3. Anterior interosseus nerve injury
      1. Motor function only: Thumb and index finger flexion
  4. Vascular injury
    1. Brachial artery injury (rare)

IX. References

  1. Eiff (2012) Fracture Management for Primary Care, Saunders, Philadelphia, p. 265-6

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