Supracondylar humerus fracture
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children.[1] In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery.[2] Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
Supracondylar humerus fracture
Orthopedic
Mechanism[edit]
Extension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow. The olecranon acts as a fulcrum which focuses the stress on distal humerus (supracondylar area), predisposing the distal humerus to fracture. The supracondylar area undergoes remodeling at the age of 6 to 7, making this area thin and prone to fractures. Important arteries and nerves (median nerve, radial nerve, brachial artery, and ulnar nerve) are located at the supracondylar area and can give rise to complications if these structures are injured. Most vulnerable structure to get damaged is median nerve.[3] Meanwhile, the flexion-type of supracondylar humerus fracture is less common. It occurs by falling on the point of the elbow, or falling with the arm twisted behind the back. This causes anterior dislocation of the proximal fragment of the humerus.[4]
Anterior and posterior sail sign in a child who has a subtle supracondylar fracture
Anterior humeral line (black line), with normal area passed on the capitulum of the humerus colored in green in a 4 year old child.[9]
![Anterior humeral line (black line), with normal area passed on the capitulum of the humerus colored in green in a 4 year old child.[9]](http://upload.wikimedia.org/wikipedia/commons/thumb/c/c9/Anterior_humeral_line.jpg/231px-Anterior_humeral_line.jpg)
The anterior humeral line is not reliable in children with sparse ossification of the capitulum, such as in this 6 months old child.[9]
![The anterior humeral line is not reliable in children with sparse ossification of the capitulum, such as in this 6 months old child.[9]](http://upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Anterior_humeral_line_in_a_6_month_old_child.jpg/247px-Anterior_humeral_line_in_a_6_month_old_child.jpg)
Epidemiology[edit]
Supracondylar humerus fractures is commonly found in children between 5 and 7 years (90% of the cases), after the clavicle and forearm fractures. It is more often occurs in males, accounting of 16% of all pediatric fractures and 60% of all paediatric elbow fractures. The mechanism of injury is most commonly due to fall on an outstretch hand.[3] Extension type of injury (70% of all elbow fractures) is more common than the flexion type of injury (1% to 11% of all elbow injuries).[4] Injury often occurs on the non-dominant part of the limb. Flexion type of injury is more commonly found in older children. Open fractures can occur for up to 30% of the cases.[3]