Snapshot An 8-year-old boy falls from a tree and lands on his outstretched right hand. He immediately develops severe elbow pain and swelling. On exam, he is unable to flex or extend his elbow due to pain. Elbow radiograph is shown and demonstrates a dorsally displaced supracondylar humerus fracture. Introduction Clinical definition fracture of the distal humerus proximal to the medial and lateral condyles Epidemiology incidence most common pediatric elbow fracture accounts for 41% of all serious pediatric elbow injuries extension type injury most common (95-98%) demographics children aged 5-7 years of age rare in adults males and females equally likely Etiology accidental trauma (e.g., fall from moderate height) fall on outstretched hand login to view 1 more bullet fall on posterior elbow login to view 1 more bullet Pathoanatomy normal anatomy humerus articulates with the radius and ulna at the elbow joint medial and lateral condyles are located at the distal portion of the humerus login to view 1 more bullet supracondylar humerus is the part of the humerus just proximal to the medial and lateral condyles fracture mechanics in an extension type injury, the olecranon process is forced against the weaker metaphyseal bone of the supracondylar humerus login to view 1 more bullet in a flexion type injury, a direct blow to the posterior elbow forces the distal condylar bone to displace anteriorly login to view 1 more bullet Associated conditions neurapraxia anterior interosseous nerve (AIN) neurapraxia login to view 3 more bullets radial nerve neurapraxia login to view 1 more bullet ulnar nerve neurapraxia login to view 1 more bullet Prognosis favorable non-displaced or minimally displaced fractures negative poor anatomic reduction vascular injury Presentation Symptoms elbow pain and limited range of motion Physical exam inspection gross deformity only in severe cases swelling ecchymosis palpation tender to palpation motion limited flexion and extension pain with passive movement neurologic exam important to assess motor and sensory nerve function login to view 4 more bullets vascular exam important to assess for vascular insufficiency login to view 2 more bullets Imaging Radiographs indication anteroposterior (AP) and lateral radiographs always indicated if fracture is suspected findings fracture line may or may not be present anterior fat pad sign (sail sign) and posterior fat pad sign login to view 1 more bullet Treatment Conservative long arm posterior splint followed by long arm casting indications login to view 2 more bullets Operative closed reduction and percutaneous pinning indications login to view 3 more bullets Differential Radial head subluxation (Nursemaid's elbow) second most common pediatric elbow injury arm held in flexion and pronation commonly occurs due to excessive traction and not a fall Lateral epicondyle fracture third most common pediatric elbow injury second most common pediatric elbow fracture will be tender on lateral side with minimal tenderness on medial side Complications Malunion cubitus varus (gunstock deformity) malalignment resulting in change from physiologic valgus elbow alignment to varus alignment cosmetic deformity with minimal functional impairment Vascular injury Volkmann ischemic contracture damage to brachial artery leads to volar compartment syndrome and muscle necrosis irreversible muscle contractures in the forearm, wrist, and hand