Supracondylar fracture (summary)

This is a basic article for medical students and other non-radiologists

Supracondylar fractures are the commonest fracture at the elbow in pediatric patients. They result from force applied across the elbow, usually following a fall. The supracondylar region is the weakest point in the developing elbow and therefore is commonly injured.

Reference article

This is a summary article; read more in our article on supracondylar fracture.

Video summary

Summary

• epidemiology

  • male=female

  • younger children: commonest 5-7 years

  • extension at the elbow (95-98%)

• presentation

  • elbow pain, swelling and reduced range of movement

  • usually follows a fall, often from climbing equipment

• pathophysiology

  • fracture of the distal humerus at its weakest point

  • dorsal angulation and displacement

  • Gartland classification used to classify fracture severity

• investigation

  • elbow series

    • allows assessment of the elbow and severity of injury

• treatment

  • depends on displacement and angulation

  • undisplaced/minimal displacement: cast only

  • severely displaced: internal fixation

Radiographic features

Plain radiograph

• elbow series

A displaced fracture of the distal humerus just above the condyles (supracondylar) is not difficult to spot. The difficult fractures are those that aren't displaced very much. 

There are two useful techniques for identifying subtle or minimally displaced fractures:

• anterior humeral line

  • draw a line down the anterior surface of the humerus

  • it should intersect the middle third of the capitellum 

  • if it passes anterior to the middle third, there is displacement

  • in the correct age group (around 5-7), think supracondylar fracture

• elbow joint effusion

  • look for evidence of a posterior fat pad

  • look for marked elevation of the anterior fat pad

  • either of these suggest an elbow joint effusion

  • if there is no other fracture, think supracondylar fracture