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Supracondylar humerus fracture in children
The most common elbow fracture in children, usually from a fall on an outstretched hand with the elbow hyperextended; the dangers are injury to the brachial artery and nerves and compartment syndrome, and a displaced fracture is treated by closed reduction and K-wire fixation.
Why it matters in the exam
The typical child is aged 5–7 and fell from play equipment, the elbow is swollen and deformed, and the question is about the neurovascular examination, the Gartland classification and urgency. The nerve most often injured in posterior displacement is the anterior interosseous nerve (AIN), a branch of the median nerve, shown by inability to make an OK sign. A pale pulseless hand is an emergency that needs immediate reduction in theatre. Pain that worsens after casting, especially on passive finger stretch, suggests compartment syndrome and Volkmann ischaemic contracture. On the lateral view, look for a posterior fat pad sign, which indicates bleeding in the joint even when the fracture line is not visible, and check the anterior humeral line, which should pass through the middle third of the capitellum. Posterior displacement is far more common than anterior displacement, which follows a fall on a flexed elbow and puts the ulnar nerve more at risk. Most displaced cases are treated in theatre under general anaesthesia within hours, but when the hand is well perfused and warm the operation can be done the next day. Postoperative care includes repeated nerve examination, and the K-wires are usually removed after about 3 weeks. Every nerve and vascular examination should be documented before and after surgery so that any change can be recognised.
Key points
- The most common elbow fracture in a child aged 5–7.
- The Gartland I–III classification guides treatment.
- The AIN is the nerve most often injured in posterior displacement.
- Pale pulseless hand — immediate reduction.
- Pain on passive stretch — suspect compartment syndrome.
Summary table
| Gartland type | Radiograph finding | Treatment |
|---|---|---|
| I | Undisplaced; sometimes only a posterior fat pad sign | Splint or cast with the elbow at about 90 degrees for 3 weeks |
| II | Displaced with the posterior cortex intact (hinged) | Closed reduction and K-wires if the anterior humeral line misses the capitellum |
| III | Completely displaced, no cortical contact | Urgent closed reduction and K-wire fixation |
| Pale pulseless hand | Risk of ischaemia | Immediate reduction in theatre; if still pale without a pulse — explore the artery |
| Pink pulseless hand | Collateral flow preserved | Reduce, fix and observe closely; explore only if arterial status worsens |
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Sources
- Rockwood and Wilkins' Fractures in Children, 9th ed. (2019) — Supracondylar Fractures of the Distal Humerus
- AAOS Clinical Practice Guideline, 2011 (reaffirmed) — The Treatment of Pediatric Supracondylar Humerus Fractures
- BOA Standards for Trauma (BOAST), 2020 — Supracondylar Fractures of the Humerus in Children
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.