Introduction
A pediatric supracondylar fracture is a break in the distal end of the humerus or upper arm bone just above the elbow joint in children.
The elbow is a complex hinge joint formed by the articulation of three bones - humerus, radius and ulna. The upper arm bone or humerus connects the shoulder to the elbow forming the upper portion of the hinge joint. The lower arm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the lower portion of the hinge joint. The bones are held together by ligaments to provide stability to the joint.
Pediatric supracondylar fractures are one of the most common type of elbow fractures seen in children, particularly in the age group of 5 to 8 years. They occur as a result of a fall on an outstretched arm or a direct blow to the elbow. Complications of the fracture may include injury to blood vessels and nerves or a malunion (crooked healing).
Types of Pediatric Supracondylar Fractures
About 98 percent of pediatric supracondylar fractures are classified as extension-type fractures. Flexion-type fractures account for around 5 percent of cases and are rare.
Extension type supracondylar fractures are further classified into:
- Type 1: Non-displaced humerus fracture with intact broken ends of the bone
- Type 2: Displaced humerus fracture with intact posterior cortex
- Type 3: Severely displaced humerus fracture with no contact to the cortex
Causes
Pediatric supracondylar fractures are quite common in children as they play and participate in sports activities. In most cases, supracondylar fractures are caused due to:
- Direct trauma to the elbow
- A fall on an outstretched arm
- A fall directly on the elbow
Signs and Symptoms
Some of the common signs and symptoms of pediatric supracondylar fractures include:
- Intense pain in the elbow
- Swelling around the elbow
- Tenderness to touch
- Visible elbow deformity
- Snapping or popping sensation at the time of injury
- Inability to straighten or move the arm
- Numbness and tingling in the fingers or hand
Diagnosis
In order to diagnose a pediatric supracondylar fracture, your physician will review your child’s medical history and conduct a physical examination of the elbow. Your physician will also examine your child’s hands and fingers to make sure that the nerves and circulation have not been affected as a result of the fracture. Your physician will then order x-rays of the distal humerus to confirm the diagnosis and determine the type and severity of the fracture.
Treatment
Treatment for pediatric supracondylar fractures depends upon the type and severity of the fracture.
Nonsurgical Treatment
Nonsurgical method is the choice of treatment for type 1 non-displaced fractures or a milder form of type 2 fracture. This involves:
- Casting and splinting: If the fracture is not too severe and the bone is correctly positioned, your physician may place the broken distal humerus in a cast or splint until the bone heals satisfactorily. In some cases, a splint is utilized initially to enable the swelling to come down and then followed by a full arm cast. Most fractures of the humerus may require the application of a cast or splint for at least 4 to 6 weeks.
- Closed reduction: For severe angled fractures in which the bones have not broken through the skin, your doctor will gently manipulate and align the bones properly without the need for surgery. This procedure is called a closed reduction and is performed under local anesthesia to numb the area while the doctor manipulates the bones, so your child is kept comfortable. Once the procedure is complete, a cast is applied to hold the bones in place while they heal.
Surgical Treatment
For severe open fractures such as type 3 in which the bone is completely displaced, surgical intervention is the choice of treatment. The 2 most common surgeries employed are:
- Closed reduction with percutaneous pinning: This is the gold standard for all displaced fractures and is extensively utilized for Type III fractures. During this procedure, your doctor will gently manipulate and reset the bones to their normal position, followed by the insertion of pins (K-wires) through the skin to rejoin and hold the fractured fragments of the bone in position while they heal. A splint is then applied for a week or two and replaced by a cast thereafter.
- Open reduction and internal fixation (ORIF): ORIF is employed if the displacement is extremely severe or if the blood vessels or nerves are damaged due to the displaced bone. During this procedure, your surgeon makes an incision to access the displaced humerus and repositions the broken bone fragments. Your surgeon may use temporary fixation devices such as K-wires to hold the broken bones in place while they heal. A splint is applied to support the elbow for a few weeks.
After the surgery, your child will be advised to come in for regular follow-ups to monitor the healing and to participate in a rehabilitation program for a quicker recovery. Recovery usually takes a month or two and varies depending on the severity of the fracture.
Risks and Complications
Pediatric supracondylar fracture repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Pin migration
- Infection
- Blood clots
- Joint stiffness
- Fracture malunion
- Persistent pain
- Ischemic contracture
- Nerve palsies
- Damage to surrounding soft-tissue structures
Summary
Children are prone to injuries and fractures as they are curious to explore their environment and engage in sports activities. The healing of fractures in children is quicker than that in adults, therefore, it is important to seek immediate medical attention if a fracture is suspected to ensure your child recovers quickly and gets back to sports and other physically demanding activities, without cosmetic or functional deficiencies.
