What is a Supracondylar fracture?
It is a bone fracture afflicting the first and largest long bone of the upper limb called the humerus.
What is a Supracondylar humerus fracture?
The humerus connects to your body at the shoulder joint and articulates distally with the ulna and radius at the elbow joint. This type of fracture occurs just about the epicondyles of the humerus bone. The epicondyles are the pair of rounded bony found just above the elbow joint at the lower end of the humerus bone. When this type of fracture occurs, it involves a posterior break of the bone, which means that the bone breaks off in a backward direction. This type of fracture is referred to as a supracondylar humerus fracture.
Supracondylar fracture in children
This is a type of fracture that is most common in children but one that you rarely see in an adult but may occur in the elderly who are suffering from weakened bones or osteoporosis. It is a fracture that is often seen in the still-developing bones of children. Although this fracture can happen from the ages of five to fifteen it is most commonly seen between the ages of five and nine years of age. It is also two times more common in males than females. The ratio of right to left side supracondylar fracture is two to three. Normally when a child has a supracondylar fracture it happens in their non-dominant arm. It is considered a serious injury because of the risk of malunion or neurovascular injury.
A supracondylar fracture has three classifications, determined by the degree of separation of the fracture fragments.
- Type 1 - this is a minimally or undisplaced fracture, which means there is a hairline fracture.
- Type 2 - this is a partially displaced fracture, which means that some bony contact is present but the fragments are nearly aligned.
- Type 3 - this is a completely displaced fracture, which means the fracture fragments are far apart from each other. With this type of fracture important blood vessels and nerves present near the elbow joint may be injured.
- Generally there is swelling, deformity at the elbow region, and pain, which will be worse when the child tries to move the arm upward
- You should look for vascular or neural symptoms such as tingling, cold, pale skin, or numbness
- In the Type 1 fracture there may not be any deformity present and only pain and mild swelling
- At the fracture site there may be tenderness and the child will avoid using the elbow.
- With a displaced fracture the deformity will be obvious
When this type of fracture occurs there is a possibility that an artery could be damaged by the broken bone so there could be severe bleeding.
A supracondylar humerus fracture happens when a child stretches out their hand to brace themselves against the impact of falling and the elbow is straightened, or hyper-extended, beyond the normal range of motion. When the child falls, the humerus will then absorb the impact of the fall. In approximately eighty percent of these cases, the humerus snaps posteriorly. This is an injury that is called an extension fracture.A supracondylar humerus fracture can also happen as a result of a:
- Impact to that area such as being hit with something hard or heavy
- Car accidents
- Gunshot wounds
The treatment depends on the type of fracture that has occurred.
- Type 1 - this fracture is treated with simple immobilization at a ninety-degree angle in a plaster cast or posterior long-arm splint without any manipulation. The child should see a pediatric orthopedic surgeon within three to five days after the injury occurred.
- Type 2 - this fracture is treated by manipulation that is followed by immobilization in a plaster cast or long-arm splint for three weeks. Within one to three days after the fracture, the child should see a pediatric orthopedic surgeon.
- Type 3 - when seen at the hospital the elbow should be splinted so it lies with twenty to thirty degrees of flexion but not tightly wrapped. The child should see the pediatric orthopedic surgeon the same day as this fracture would require operative treatment. The surgeon will attempt to reduce the fracture without exposing the bone fragments by making an incision. If this step is successful, the fracture will be held into place by one point five to two millimeters of K wires, which are stainless steel wires. If this step is not successful, the fracture will be exposed by the incision. Under vision, the bone fragments are aligned and then held in place by the K wires.
With a supracondylar fracture there are several complications that can occur, which include:
- Nerve injury - this complication occurs in approximately ten to fifteen percent of fractures. The nerve that runs close to the supracondylar fracture area is called the median nerve and could be damaged. Symptoms that could indicate damage can include tingling, weakness, or numbness in the forearm, hand, or elbow.
- Malunion, which is when a fracture unites in a wrong position referred to as a gunstock deformity.
- Vascular injury -this complication occurs in approximately thirteen to twenty percent of children with a displaced supracondylar fracture resulting in an absent or diminished pulse. Their artery that runs very close to the supracondylar fracture area is called the brachial artery so this artery may be damaged. Symptoms that you should watch for are skin in the hand or forearm that is cold, pale, and clammy or having extensive bruising at their elbow.
- Compartment-syndrome, which is when the blood flow in a closed compartment is blocked or reduced by an increase in the pressure within that compartment and can cause death of tissues in that compartment. These tissues can include skin, muscles, nerves, etc.Loss of movement in that arm where the child cannot completely straighten the elbow
Normally at the end of three weeks there is enough soft bone that unites the fracture has formed to allow restricted activity so this is when the cast is removed. To get complete movement back in your elbow joint can take two to three months.