Skip to main content
SpringerLink
Log in

Supracondylar Humerus Fractures in Children

  • Living reference work entry
  • Latest version View entry history
  • First Online:
The Pediatric Upper Extremity

  • 28 Accesses

Abstract

Supracondylar humerus fractures are the most common elbow fractures in children. While nondisplaced type I supracondylar fractures can be managed nonoperatively with casting, operative fixation with closed reduction and percutaneous pinning (CRPP) is indicated for most displaced injuries (types II, III, and IV). Two or three lateral pins are usually sufficient to stabilize most fractures; however, in very rare cases of persistent instability after a third lateral pin, a medial pin may be required. Consideration of management of supracondylar humerus injuries should include a thorough evaluation of limb perfusion as this has consequences for treatment. Limbs that regain perfusion but remain pulseless after operative fixation can be observed for an additional 48 h, but limbs that remain poorly perfused require urgent open exploration. Surgical management of supracondylar humerus fractures has good outcomes and low complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Abe M, Ishizu T, Shirai H, Okamoto M, Onomura T. Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg Am. 1995;20(1):5–9.

    Article  PubMed  Google Scholar 

  • Abe M, Ishizu T, Morikawa J. Posterolateral rotatory instability of the elbow after posttraumatic cubitus varus. J Shoulder Elb Surg. 1997;6(4):405–9.

    Article  Google Scholar 

  • Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg. 2012;20(2):69–77.

    Article  PubMed  Google Scholar 

  • Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253–63.

    Article  PubMed  Google Scholar 

  • Badkoobehi H, Choi PD, Skaggs DL, Bae DS. Current concepts review: management of the pulseless pediatric supracondylar humeral fracture. J Bone Jt Surg Am. 2014;97(11):937–43.

    Article  Google Scholar 

  • Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21(5):680–8.

    Article  PubMed  Google Scholar 

  • Baghdadi S, CORTICES. Pediatric floating elbow injuries are not as problematic as they were once thought to be: a systematic review. J Pediatr Orthop. 2020;40(8):380–6.

    Article  PubMed  Google Scholar 

  • Barrett KK, Skaggs DL, Sawyer JR, Andras L, Moisan A, Goodbody C, et al. Supracondylar humeral fractures with isolated anterior interosseous nerve injuries: is urgent treatment necessary? J Bone Jt Surg Am. 2014;96(21):1793–7.

    Article  Google Scholar 

  • Bashyal RK, Chu JY, Schoenecker PL, Dobbs MB, Luhmann SJ, Gordon JE. Complications after pinning of supracondylar distal humerus fractures. J Pediatr Orthop. 2009;29(7):704–8.

    Article  PubMed  Google Scholar 

  • Battaglia TC, Armstrong DG, Schwend RM. Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop. 2002;22(4):431–9.

    Article  PubMed  Google Scholar 

  • Blakemore LC, Cooperman DR, Thompson GH, Wathey C, Ballock RT. Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop Relat Res. 2000;376:32–8.

    Article  Google Scholar 

  • Blumberg TJ, Bremjit P, Bompadre V, Steinman S. Forearm fixation is not necessary in the treatment of pediatric floating elbow. J Pediatr Orthop. 2018;38(2):82–7.

    Article  PubMed  Google Scholar 

  • Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. 1995;15(4):440–3.

    Article  PubMed  Google Scholar 

  • Brubacher JW, Dodds SD. Pediatric supracondylar fractures of the distal humerus. Curr Rev Musculoskelet Med. 2008;1(3–4):190–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15(1):47–52.

    Article  PubMed  Google Scholar 

  • Carrazzone OL, Barbachan Mansur NS, Matsunaga FT, Matsumoto MH, Faloppa F, Belloti JC, et al. Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials. J Shoulder Elb Surg. 2021;30(2):439–48.

    Article  Google Scholar 

  • Catterall A. Rockwood and Wilkins’ fractures in children. J Bone Joint Surg Br. 2002;84-B:465.

    Article  Google Scholar 

  • Charnley J. Closed treated of common fractures. Edinburg: Churchill Livingstone; 1961.

    Google Scholar 

  • Cheng JCY, Shen Y. Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma. 1993;7(1):15–22.

    Article  PubMed  Google Scholar 

  • Cheng JCY, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1995;9(6):511–5.

    Article  PubMed  Google Scholar 

  • Cheng JCY, Ng BKW, Ying SY, Lam PKW. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. J Pediatr Orthop. 1999;19(3):344–50.

    Article  PubMed  Google Scholar 

  • Cheng JCY, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001;10(1):63–7.

    PubMed  Google Scholar 

  • Copley LA, Dormans JP, Davidson RS. Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention. J Pediatr Orthop. 1996;16(1):99–103.

    Article  PubMed  Google Scholar 

  • Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough? Pediatr Emerg Care. 2012;28(11):1150–3.

    Article  PubMed  Google Scholar 

  • Farnsworth C, Silva P, Mubarak S. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998;18(1):38–42.

    Article  PubMed  Google Scholar 

  • Fitzgibbons PG, Bruce B, Got C, Reinert S, Solga P, Katarincic J, et al. Predictors of failure of nonoperative treatment for type-2 supracondylar humerus fractures. J Pediatr Orthop. 2011;31(4):372–6.

    Article  PubMed  Google Scholar 

  • Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long term follow up. J Bone Jt Surg A. 1974;56(2):263–72.

    Article  Google Scholar 

  • Flynn K, Shah AS, Brusalis CM, Leddy K, Flynn JM. Flexion-type supracondylar humeral fractures: ulnar nerve injury increases risk of open reduction. J Bone Joint Surg Am. 2017;99(17):1485.

    Article  PubMed  Google Scholar 

  • Fowles JV, Kassab MT. Displaced supracondylar fractures of the elbow in children. A report on the fixation and extension and flexion fractures by two lateral percutaneous pins. J Bone Jt Surg B. 1974;56B(3):490–500.

    Article  Google Scholar 

  • Franklin CC, Skaggs DL. Approach to the pediatric supracondylar humeral fracture with neurovascular compromise. Instr Course Lect. 2013;62:429–33.

    PubMed  Google Scholar 

  • Gartland J. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109:145–54.

    PubMed  Google Scholar 

  • Gaston RG, Cates TB, Devito D, Schmitz M, Schrader T, Busch M, et al. Medial and lateral pin versus lateral-entry pin fixation for type 3 supracondylar fractures in children: a prospective, surgeon-randomized study. J Pediatr Orthop. 2010;30(8):799–806.

    Article  PubMed  Google Scholar 

  • Gosens T, Bongers KJ. Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children. Injury. 2003;34(4):267–73.

    Article  PubMed  Google Scholar 

  • Harrington P, Sharif I, Fogarty EE, Dowling FE, Moore DP. Management of the floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm. Arch Orthop Trauma Surg. 2000;120(3–4):205–8.

    Article  PubMed  Google Scholar 

  • Herman MJ, Boardman MJ, Hoover JR, Chafetz RS. Relationship of the anterior humeral line to the capitellar ossific nucleus: variability with age. J Bone Jt Surg A. 2009;91(9):2188–93.

    Article  Google Scholar 

  • Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, et al. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg. 2012 May;20(5):320–7.

    Article  PubMed  Google Scholar 

  • Karakurt L, Ozdemir H, Yilmaz E, Inci M, Belhan O, Serin E. Morphology and dynamics of the ulnar nerve in the cubital tunnel after percutaneous cross-pinning of supracondylar fractures in children’s elbows: an ultrasonographic study. J Pediatr Orthop B. 2005;14(3):189–93.

    Article  PubMed  Google Scholar 

  • Karger C. James H. Beaty, James R. Kasser (eds.), John M. Flynn, David L. Skaggs, Peter M. Waters (Ass. eds.): Rockwood and Green’s fractures in children, 7th edn. Eur J Orthop Surg Traumatol. 2011;21:385.

    Article  Google Scholar 

  • Kasser JR, Beaty JH. Supracondylar fracture of the distal humerus. In: Rockwood Wilkins fractures in children. Philadelphia: Lipincott Williams and Wilkins; 2006. p. 543–89.

    Google Scholar 

  • Kay RM, Directo MP, Leathers M, Myung K, Skaggs DL. Complications of ketorolac use in children undergoing operative fracture care. J Pediatr Orthop. 2010;30(7):655–8.

    Article  PubMed  Google Scholar 

  • Kurer MHJ, Regan MW. Completely displaced supracondylar fracture of the humerus in children. A review of 1708 comparable cases. Clin Orthop Relat Res. 1990;256:205–14.

    Article  Google Scholar 

  • Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectionally unstable supracondylar humeral fractures in children: a modified Gartland type-IV fracture. J Bone Jt Surg A. 2006;88(5):980–5.

    Article  Google Scholar 

  • Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM. Does the modified Gartland classification clarify decision making? J Pediatr Orthop. 2018;38(1):22–6.

    Article  PubMed  Google Scholar 

  • Louahem DM, Nebunescu A, Canavese F, Dimeglio A. Neurovascular complications and severe displacement in supracondylar humerus fractures in children: defensive or offensive strategy? J Pediatr Orthop B. 2006;15(1):51–7.

    Article  PubMed  Google Scholar 

  • Mahan ST, May CD, Kocher MS. Operative management of displaced flexion supracondylar humerus fractures in children. J Pediatr Orthop. 2007a;27(5):551–6.

    Article  PubMed  Google Scholar 

  • Mahan ST, May CD, Kocher MS. Operative management of displaced flexion supracondylar humerus fractures in children. J Pediatr Orthop. 2007b Jul;27(5):551–6.

    Article  PubMed  Google Scholar 

  • Makhni MC, Makhni EC, Swart EF, Day CS. Distal humerus physeal separation. In: Orthopedic emergencies. Cham: Springer International Publishing; 2017. p. 427–9.

    Chapter  Google Scholar 

  • Mapes RC, Hennrikus WL. The effect of elbow position on the radial pulse measured by Doppler ultrasonography after surgical treatment of supracondylar elbow fractures in children. J Pediatr Orthop. 1998;18(4):441–4.

    Article  PubMed  Google Scholar 

  • Mubarak SJ, Carroll NC. Volkmann’s contracture in children: aetiology and prevention. J Bone Jt Surg B. 1979;61(3):285–93.

    Article  Google Scholar 

  • Muchow RD, Riccio AI, Garg S, Ho CA, Wimberly RL. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children. J Pediatr Orthop. 2015;35(2):121–5.

    Article  PubMed  Google Scholar 

  • Nork SE, Hennrikus WL, Loncarich DP, Gillingham BL, Lapinsky AS. Relationship between ligamentous laxity and the site of upper extremity fractures in children: extension supracondylar fracture versus distal forearm fracture. J Pediatr Orthop B. 1999;8(2):90–2.

    PubMed  Google Scholar 

  • O’Driscoll SW, Spinner RJ, McKee MD, Ben Kibler W, Hastings H, Morrey BF, et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Jt Surg A. 2001;83(9):1358–69.

    Article  Google Scholar 

  • Okubo H, Nakasone M, Kinjo M, Onaka K, Futenma C, Kanaya F. Epidemiology of paediatric elbow fractures: a retrospective multi-centre study of 488 fractures. J Child Orthop. 2019;13(5):516–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Jt Surg A. 2008;90(5):1121–32.

    Article  Google Scholar 

  • Otsuka N. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg. 1997;5:19–26.

    Article  PubMed  Google Scholar 

  • Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Jt Surg A. 1988;70(5):641.

    Article  Google Scholar 

  • Ramesh P, Avadhani A, Shetty AP, Dheenadhayalan J, Rajasekaran S. Management of acute “pink pulseless” hand in pediatric supracondylar fractures of the humerus. J Pediatr Orthop B. 2011;20(3):124–8.

    Article  PubMed  Google Scholar 

  • Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1998;18(5):686–90.

    Article  PubMed  Google Scholar 

  • Reitman RD, Waters P, Millis M. Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop. 2001;21(2):157–61.

    Article  PubMed  Google Scholar 

  • Ring D, Waters PM, Hotchkiss RN, Kasser JR. Pediatric floating elbow. J Pediatr Orthop. 2001;21(4):456–9.

    Article  PubMed  Google Scholar 

  • Ristic S, Strauch RJ, Rosenwasser MP. The assessment and treatment of nerve dysfunction after trauma around the elbow. Clin Orthop Relat Res. 2000;370:138–53.

    Article  Google Scholar 

  • Ryan DD, Lightdale-Miric NR, Joiner ERA, Wren TAL, Spragg L, Heffernan MJ, et al. Variability of the anterior humeral line in normal pediatric elbows. J Pediatr Orthop. 2016;36(2):14–6.

    Article  Google Scholar 

  • Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Jt Surg A. 2007;89(4):713–7.

    Google Scholar 

  • Schoenecker PL, Delgado E, Rotman M, Sicard GA, Capelli AM. Pulseless arm in association with totally displaced supracondylar fracture. J Orthop Trauma. 1996;10(6):410–5.

    Article  PubMed  Google Scholar 

  • Skaggs DL, Flynn JM. Supracondylar fractures of the distal humerus. In: Rockwood and Wilkins’: fractures in children. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2015. p. 581–628.

    Google Scholar 

  • Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Jt Surg A. 1999;81(10):1429–33.

    Article  Google Scholar 

  • Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children: the consequences of pin placement. J Bone Jt Surg A. 2001;83(5):735–40.

    Article  Google Scholar 

  • Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Jt Surg A. 2004;86(4):702–7.

    Article  Google Scholar 

  • Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008;28(2):139–41.

    Article  PubMed  Google Scholar 

  • Slobogean BL, Jackman H, Tennant S, Gerard Z, PS, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. J Pediatr Orthop. 2010;30(5):430–6.

    Article  PubMed  Google Scholar 

  • Swanson CE, Chang K, Schleyer E, Pizzutillo PD, Herman MJ. Postoperative pain control after supracondylar humerus fracture fixation. J Pediatr Orthop. 2012;32(5):452–5.

    Article  PubMed  Google Scholar 

  • Templeton PA, Graham HK. The “floating elbow” in children: simultaneous supracondylar fractures of the humerus and of the forearm in the same upper limb. J Bone Jt Surg B. 1995;77(5):791–6.

    Article  Google Scholar 

  • Valencia M, Moraleda L, Díez-Sebastián J. Long-term functional results of neurological complications of pediatric humeral supracondylar fractures. J Pediatr Orthop. 2015;35(6):606–10.

    Article  PubMed  Google Scholar 

  • Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018;3(10):526–40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Waters PM, Bae DS. Distal humerus fractures. In: Pediatric hand and upper limb surgery: a practical guide. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 287–315.

    Google Scholar 

  • Weiland AJ, Meyer S, Tolo VT, Berg HL, Mueller J. Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years. J Bone Jt Surg A. 1978;60(5):657–61.

    Article  Google Scholar 

  • Weinstein SL, Flynn JM, Crawford HA. Upper extremity fractures. In: Lovell and Winter’s pediatric orthopaedics. 8th ed. Philadelphia: Wolters Kluwer; 2021.

    Google Scholar 

  • Wilkins K. Fractures and dislocations of the elbow region. In: Rockwood Wilkins fractures in children, vol. 3. Lippincott-Raven; 1984. p. 363–575.

    Google Scholar 

  • Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2021;16(1):366.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors wish to recognize the work of previous author Afamefuna Nduaguba, MD and colleagues for their contributions to The Pediatric Upper Extremity and to this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Joseph L. Yellin, Patrick England & John M. Flynn

Authors
  1. Joseph L. Yellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick England
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John M. Flynn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph L. Yellin .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedics, U. of Maryland School of Medicine, Timonium, MD, USA

    Joshua M. Abzug

  2. Shriners Hospital for Children - Phila., Philadelphia, PA, USA

    Scott Kozin

  3. Shriners Hospital For Children - Phila., Philadelphia, PA, USA

    Dan A. Zlotolow

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Yellin, J.L., England, P., Flynn, J.M. (2023). Supracondylar Humerus Fractures in Children. In: Abzug, J.M., Kozin, S., Zlotolow, D.A. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8758-6_52-2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8758-6_52-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8758-6

  • Online ISBN: 978-1-4614-8758-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Supracondylar Humerus Fractures in Children
    Published:
    19 October 2023

    DOI: https://doi.org/10.1007/978-1-4614-8758-6_52-2

  2. Original

    Supracondylar Humerus Fracture
    Published:
    03 July 2014

    DOI: https://doi.org/10.1007/978-1-4614-8758-6_52-1

Search

Navigation