Supracondylar Humerus Fractures

Supracondylar humerus fractures are one of the most common fractures in children, and account for over half of the fractures around the elbow alone. It is an injury that Children’s Orthopedics of Atlanta treats every day. It is most common in children ages 5-7, but it is not uncommon outside this range. It occurs in equally in boys and girls.  The break, or fracture, occurs just above the elbow joint, through the humerus. When a child places her hand out in front out in front of her to break her fall, she does so with the elbow joint locked straight.  At that moment, the top part of the ulna bone (known as the olecranon) is forced into the thin olecranon fossa of the humerus, causing the bone to break.  During the ages of 5-7, the olecranon fossa is very thin, and thus more likely to break.

Many of these fractures are minimally displaced, meaning that the bones are not too far separated from each other.  If that is the case, often times, your clinician (doctor or PA/NP) will recommend cast treatment for several weeks.  However, if the bones are separated from each other and appear crooked on x-rays, than most likely you're COA surgeon will recommend surgery in order to help align the bones and then maintain the alignment.  

Most of the time, your doctor will not need to make any incisions to align (aka "reduce") the bones back in place.  However, to ensure that the bones do not move once they are aligned, your surgeon will place 2-3 sterile metal pins through the skin, inside the bone, and across the fracture to hold it in place. Those pins stay outside the skin but are protected underneath the cast. Those pins are removed after approximately 3-4 weeks in the office.

Removing the pins in the office is not painful, but some children become very frightened by either the removal of the cast or pulling of the pins. We recommend that you bring a distraction for your child – headphones with music, a tablet or phone, or a favorite toy or game are often very helpful.

Once the pins are removed, your child will either be placed back in a cast for a few weeks, or more likely, will be allowed to start moving his arm.

The majority of the time, there are no long-term consequences of having one of these elbow fractures. Some children may be a little stiffer on the fractured side versus the non-fractured side, and occasionally, the bone does not heal in the exact position as it was placed during surgery.  

Below is an example of an 8 year old girl who fell and suffered a supracondylar humerus fracture.  The bone was severely displaced, and thus surgery was recommended to align the bones.  The x-ray on the left represent her injury films.  The middle radiograph is 3 weeks after the surgery in which the cast, and then the pins, were removed in the office.  The final radiograph was 4 weeks later, or 7 weeks from the injury showing the bone completely healed.  She no longer needed any additional follow-up as she was pain free and had no stiffness.