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Emergency: requires immediate attention
Pediatric supracondylar fracture of humerus
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Emergency: requires immediate attention

Pediatric supracondylar fracture of humerus

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Contributors: Peter Joo, David Sullo MD, Michael W. Winter MD
Other Resources UpToDate PubMed

Synopsis

Pediatric supracondylar fracture of the humerus is the most common pediatric elbow injury, involving a fracture of the distal humerus just above the epicondyles. Often due to a fall on an outstretched hand or traumatic injury, this is characterized by elbow pain, swelling, and decreased range of motion. Damage to ulnar, radial, and media nerves can cause loss of sensation, nerve paralysis, or motor impairment. It may be a mild and self-resolving neuropraxia, or it may lead to irreversible neurological damage. Vascular damage may also occur, and blood flow to the arm may be compromised due to compression from the fracture or increased compartmental pressures caused by swelling. Complications include Volkmann ischemic contracture and acute compartment syndrome, which require urgent intervention.

The Gartland classification (modified) divides supracondylar fracture into 4 types by severity:
  • Type 1 – Nondisplaced.
  • Type 2 – Angulation present but a posterior bony hinge remains intact.
  • Type 3 – Complete displacement with no bony hinge. Periosteum is usually intact.
  • Type 4 – Complex, unstable, multidirectional fracture.
Management depends on the severity of injury, with treatments ranging from immobilization and pain medication (resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here) to a variety of surgical procedures involving closed reduction, open reduction, percutaneous pinning, or k-wires. The most common complication following treatment is gun-stock deformity (cubitus varus) due to malunion during the healing process.

Codes

ICD10CM:
S42.426A – Nondisplaced comminuted 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

  • Fractures above and below the elbow (wrist, forearm, shoulder, clavicle) should be considered, especially in younger children who may not localize symptoms well.
  • Nursemaid's elbow should be considered in a child with an elbow injury with normal x-rays, as should a Salter-Harris type 1 injury.
  • Child abuse should be considered if other signs are present, such as multiple fractures or bruises and avoidance behaviors.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 03/27/2019
Last Updated: 03/27/2019
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Emergency: requires immediate attention
Pediatric supracondylar fracture of humerus
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Pediatric supracondylar fracture of humerus : Decreased range of motion, Elbow pain, Joint swelling
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