Epidemiology: The most common fracture in children <8 years old.
- The majority occur between 3-10 years old with peak age 5-7 years old .
- Malunion, ischemic (Volkmann) contracture from brachial artery damage / volar compartment syndrome, nerve injuries .
- Most common: injury to the anterior interosseous nerve .
Physical Exam: Tenderness at the elbow. S-shape deformity in severe fracture.
- Evaluate the function of the anterior interosseous nerve (AIN) (figure 1), radial artery, ulnar nerve, and radial nerve.
Pearl: If the radial pulse is missing, management differs depending on perfusion.
- If the hand is poorly perfused, perform emergent traction and/or reduction .
- If the hand is well-perfused, consult orthopedics emergently. This is a contraindication to manipulation in the emergency department [2, 3].
Diagnostic Imaging: Fracture of the distal humerus, possibly with posterior displacement.
- Type I (non-displaced): Long arm splint/cast and prompt ortho follow-up within 2-7 days.
- Type II (displaced with intact posterior cortex): ED orthopedic consultation.
- Type III (complete displacement): ED orthopedic consultation.
Figure 1: A) Median nerve assessment. B) Simulation of anterior interosseous nerve neurapraxia.
Figure 2: Lateral and AP X-rays of type 1 supracondylar fracture with posterior fat pad (blue arrows), anterior cortical disruption (red arrows) and displacement of anterior humeral line (green dotted line). Case courtesy of Dr. Frank Gaillard, Radiopaedia.org. Annotations by Daniel Ichwan, MD.
Figure 3: Lateral X-ray of (a) type 2 supracondylar fracture with anterior cortical disruption (red arrow) without posterior cortical disruption. Case courtesy of Dr. Mohamed Walaaedlin, Radiopaedia.org. Annotations by Daniel Ichwan, MD. (b) type 3 supracondylar fracture with complete displacement. Case courtesy of Dr. Benoudina Samir, Radiopaedia.org.