Supracondylar Elbow Fracture

• Most common elbow fracture in children, peak age 5-7 

• When looking at an elbow x-ray review alignment (anterior radiocapitellar lines), fat pads (anterior & posterior) and bone cortex 

• If a fracture cannot be identified but anterior sail sign or posterior fat pad is seen, or radiocapitellar line is disrupted, treat as non-displaced supracondylar fracture' 

• Ossification centers: "CRITOE"; capitellum (age 1), radial head (age 3), internal epicondyle (age 5), trochlea (age 7), olecranon (age 9), external epicondyle (age 11) 

• Mechanism: Fall onto outstretched hand 

• Exam: Swelling and refusal to move elbow 

• Possible associated injuries: Neuropraxia (anterior interosseous nerve [can't make A-OK sign] most common), brachial artery injury (leads to Volkmann contracture), compartment syndrome 

• ED Management: Pain control 

• Splint: Posterior long arm 

• Ortho consult: No, if Type I; Yes, if Types II-IV 

• Disposition: Type l, DC with ortho follow-up within 1 week; Types II-IV, pending orthopedic recommendations 



MH/CCF/CWRU EM Res @MetroHealth_EM



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