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Evaluation and management of supracondylar fractures in children

Topic Outline

GRAPHICS

INTRODUCTION

Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise [1-4]. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications [1]. Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose the greatest risk for long-term complications.

This topic will discuss the evaluation and treatment of supracondylar fractures in children. Other distal humeral fractures are discussed separately. (See "Evaluation and management of condylar elbow fractures in children" and "Epicondylar and transphyseal elbow fractures in children".)

EPIDEMIOLOGY

Supracondylar fractures account for up to 60 percent of pediatric elbow fractures [4]. They occur most frequently in children between 5 and 10 years of age [5]. Supracondylar fractures result from a fall on an outstretched arm in up to 70 percent of patients [6]. The nondominant extremity is most commonly affected. Children under three years of age typically sustain a supracondylar fracture after a fall from a height of less than three feet (eg, fall from a bed or couch). Most fractures in older children result from higher falls from playground equipment (eg, monkey bars, swings) or other high energy mechanism [7].

PERTINENT ANATOMY

Bone — In children, the supracondylar region encompasses an area of thin, weak bone located in the distal humerus. This region is bordered posteriorly by the olecranon fossa and anteriorly by the coronoid fossa (figure 1). The medial and lateral aspects of the supracondylar region extend distally to the developing medial and lateral condyles and epicondyles.

When a child falls onto an outstretched arm with the elbow in hyperextension, the force of the fall is transmitted through the olecranon to the weak supracondylar region, causing a supracondylar fracture. Depending on the severity of the fracture, posterior displacement of the distal fracture fragment and anterior displacement of the proximal fracture fragment may occur (figure 2). The fracture line typically propagates transversely across the distal humerus through the center of the olecranon fossa (image 1). (See 'Supracondylar fracture classification' below.)

                                     

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Literature review current through: Jun 2014. | This topic last updated: Feb 10, 2014.
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References
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