Supracondylar Fracture

Symptoms of a Supracondylar Fracture

• Sudden onset of elbow pain after a traumatic incident.
• Tender to touch the area.
• Swelling may be present, especially in type 2 and 3 injuries.
• The elbow may appear deformed in type 2 and 3 injuries.
• Pain worsens when trying to move the arm.
• Look out for neural or vascular symptoms such as numbness, tingling or cold, pale skin.
• In type 1 injuries, it may not be clear that there is a fracture present due to mild swelling and pain. Watch out for a child guarding and not using the elbow.

Classifications

A supracondylar fracture can be classified as follows:

• Type 1 - Un displaced - bones aligned and no deformity.
• Type 2 - Partially displaced - bones fragment moved partially - minor deformity
• Type 3 - Displaced - bones fragment completely separated - major deformity.

Treatment

Treatment depends on the level of displacement:

• Type 1 require simple immobilisation in a cast for 4-6 weeks.
• Type 2 may require manipulation first to realign the bone sections, before being immobilised in a cast as above.
• Type 3 requires surgery to realign the bones and hold them in place with pins or wires, before immobilisation in a splint for the first few days and then a cast.

Complications

There are a number of complications which may occur following a supracondylar fracture. These become more likely as the severity increases.

• Loss of movement - many patients lose the ability to completely straighten the elbow.
• Vascular injuries - the brachial artery runs very close to the fracture area and so may be damaged. Symptoms such as cold, clammy, pale skin in the forearm or hand, or extensive bruising at the elbow may indicate this.
• Nerve injury - the median nerve runs very close to the fracture area and so may be damaged. Watch out for symptoms such as numbness, tingling or weakness in the elbow, forearm or hand.
• Mal union - the two parts of bone do not heal in line.