A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow.
Supracondylar fractures are the most common type of upper arm injury in children. They are frequently caused by a fall on an outstretched elbow or a direct blow to the elbow. These fractures are relatively rare in adults.
Surgery isn’t always required. Sometimes a hard cast may be enough to promote healing.
Complications of supracondylar fracture can include injury to nerves and blood vessels, or crooked healing (malunion).
Symptoms of a supracondylar fracture
Symptoms of supracondylar fracture include:
- sudden intense pain in the elbow and forearm
- a snap or pop at time of injury
- swelling around the elbow
- numbness in the hand
- inability to move or straighten the arm
Risk factors for this type of fracture
Supracondylar fractures were once thought to be more common in boys. But recent studies show that girls are just as likely as boys to have this type of fracture.
The injury is more likely to occur during summer months.
Diagnosing a supracondylar fracture
If a physical examination shows likelihood of a fracture, the doctor will use X-rays to determine where the break occurred, and to distinguish a supracondylar fracture from other possible types of injuries.
If the doctor identifies a fracture, they will classify it by type using the Gartland system. The Gartland system was developed by Dr. J.J. Gartland in 1959.
If you or your child has an extension fracture, that means the humerus has been pushed backward from the elbow joint. These make up about 95 percent of supracondylar fractures in children.
If you or your child is diagnosed with a flexion injury, that means that the injury has been caused by a rotation of the elbow. This type of injury is less common.
Extension fractures are further classified into three main types depending on how much the upper arm bone (humerus) has been displaced:
- type 1: humerus not displaced
- type 2: humerus moderately displaced
- type 3: humerus severely displaced
In very young children, the bones may not be sufficiently hardened to show up well on an X-ray. Your doctor may also request an X-ray of the uninjured arm to make a comparison.
The doctor will also look for:
- tenderness around the elbow
- bruising or swelling
- limitation of movement
- possibility of damage to nerves and blood vessels
- restriction of blood flow indicated by a change in color of the hand
- possibility of more than one fracture around the elbow
- injury to the bones of the lower arm
Treating this fracture
If you suspect you or your child has a supracondylar or other type of fracture, see your doctor or go to the emergency room as soon as possible.
Surgery is usually not necessary if the fracture is a type 1 or a milder type 2, and if there are no complications.
A cast or a splint can be used to immobilize the joint and allow the natural healing process to begin. Sometimes a splint is used first to allow the swelling to go down, followed by a full cast.
It may be necessary for the doctor to set the bones back into place before applying the splint or cast. If that’s the case, they will give you or your child some form of sedation or anesthesia. This nonsurgical procedure is called a closed reduction.
More severe fractures
Severe injuries may require surgery. The two main types of surgery are:
- Closed reduction with percutaneous pinning. Along with resetting of the bones as described above, your doctor will insert pins through the skin to rejoin the fractured parts of the bone. A splint is applied for the first week and then replaced by a cast. This is the most common form of surgery.
- Open reduction with internal fixation. If the displacement is more severe or there is damage to the nerves or blood vessels, open surgery will likely be needed.
Open reduction is required only occasionally. Even the more severe type 3 injuries can often be treated by closed reduction and percutaneous pinning.
What to expect during recovery
You or your child will likely need to wear a cast or splint for three to six weeks, whether treated by surgery or simple immobilization.
For the first few days, it helps to elevate the injured elbow. Sit next to a table, place a pillow on the table, and rest the arm on the pillow. This shouldn’t be uncomfortable, and it may help speed recovery by promoting blood circulation to the injured area.
It may be more comfortable to wear a loose-fitting shirt and let the sleeve on the cast side hang free. Alternatively, cut the sleeve on old shirts that you aren’t planning to use again, or purchase some inexpensive shirts you can alter. That can help accommodate the cast or splint.
Regular visits to your doctor are needed to make sure the damaged bone is rejoining properly.
Your doctor may recommend targeted exercises to improve the elbow range of motion as healing continues. Formal physical therapy is occasionally needed.
What to do after surgery
Some pain is likely after the pins and cast are in place. Your doctor may suggest over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol).
It’s normal for a low-grade fever to develop within the first 48 hours after surgery. Call your doctor if your or your child’s temperature goes above 101°F (38.3°C) or lasts for more than three days.
If your child is injured, they may be able to return to school within three to four days after surgery, but they should avoid sports and playground activities for at least six weeks.
If pins are used, these are normally removed in the doctor’s office three to four weeks after surgery. There’s often no need for anesthesia in this procedure, although there may be some discomfort. Children sometimes describe it as “it feels funny,” or “it feels weird.”
Total recovery time from the fracture will vary. If pins were used, 72 percent of elbow range of motion may be recovered by six weeks after surgery. This increases to 94 percent after 26 weeks, and 98 percent after a year.
The most common complication is the failure of the bone to rejoin properly. This is known as malunion. This can occur in up to 50 percent of children who have been treated surgically. If the misalignment is recognized early in the recovery process, quick surgical intervention may be needed to make sure the arm will heal straight.
Outlook for supracondylar fractures
Supracondylar fracture of the humerus is a common childhood injury to the elbow. If treated quickly, either by immobilizing with a cast or by surgery, the prospects for full recovery are very good.