2.  A 7yo female
presents with
elbow pain after
FOOSH. Exam
reveals minimal
swelling and
severe pain of
her right elbow

4.  Fat pads
 Displacement (“sail sign”) of
anterior fat pad
 Posterior fat pad is always
abnormal
 Anterior humeral line
 Draw a longitudinal line along
anterior border of humerus on
lateral view
 If line falls in anterior third or
entirely anterior to capitellum, a
posteriorly displaced
supracondylar fracture is likely

5.  Nondisplaced fractures
 Immobilized with elbow flexed to 90°
 Displaced fractures
 In pediatrics, if posterior cortex is intact, fx can be managed with
closed reduction and percutaneous fixation by the orthopedist
 If fracture is open, not reducible by closed means, coexists with
forearm fractures or has NV compromise after closed reduction, open
reduction is warranted
 Orthopedics
 Should be consulted to determine management of any displaced
supracondylar fractures
 Disposition
 Even if closed reduction successful, most of these injuries require
admission for serial exams because of risk of compartment syndrome
 Discharged pts require careful return instructions

6.  Traditionally a pediatric fracture, but can be in adults
 Pediatric fractures often occur through growth plates, so a
fracture line may not be visible; therefore, you must check
for abnormal fat pads and misalignment!
 Palpate distal radius
 Associated fracture in 5-6%
 Risk for nerve damage
 Anterior interosseous branch of median nerve
 Less commonly, radial nerve
 Vascular compromise
 Occurs in 5-17% from brachial artery injury or compartment
syndrome
 Volkmann’s ischemic contracture is a devastating
consequence of missed vascular injury

9.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s
emergency medicine. 7th ed.
 Simon R; Sherman S; Koenigsknecht S. Emergency
orthopedics: the extremities. 5th ed. McGraw Hill
Publishing.
 Wheeless C R III MD. Wheeless textbook of
orthopedics. www.wheelessonline.com.