Supracondylar Humerus Fracture

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The humerus (HU mer us) bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow.  Your child’s humerus is fractured (broken) near the elbow area, just above the joint.  This is called a supracondylar (supra CON dy ler) humerus fracture.  It is the most common type of elbow fracture and happens most often to children younger than 8 years old.

Common causes of injury

Bones of the arm and shoulder

  • A fall onto an outstretched arm
  • A fall directly onto the elbow
  • A direct blow to the elbow

Symptoms of supracondylar fracture

  • Pain in the elbow
  • Swelling in the elbow and hand
  • Obvious deformity of the elbow or arm
  • Cannot move the elbow due to pain
  • Numbness in the fingers or hand
  • Fingers or hand of the injured arm are cool, cold or blue

Diagnosis

  • The practitioner will ask how the injury occurred and will perform a complete examination to assess pain, swelling, and circulation.
  • X-rays will be obtained to determine if the fracture is displaced (has moved out of acceptable alignment).

Treatment

Nonsurgical

  • If the humerus fracture is not displaced, your child can be treated with a cast for a few weeks until the fracture heals.
  • Your child will follow up in the Orthopedic Clinic for further x-rays and treatment.

Surgical

  • If the bone is displaced, your child will require surgery to put the bone back into place. This surgery will be done in the operating room.
  • If your child needs surgery, he or she may have thin pins placed into the end of the humerus bone to keep the bone from moving. This procedure is called closed reduction and percutaneous pinning.See Helping Hand HH-I-415, Percutaneous Pinning. “Percutaneous” means “through the skin.” When your child is asleep, a surgeon will reduce (set) the fracture. The doctor will insert pins to hold the fracture in position until the bone is healed. If the bone cannot be aligned with the pins, occasionally the surgeon will have to make a small incision to see the fracture and place the pins this way.
  • Your child will be placed into a splint or cast for 3 to 4 weeks until the bone is healed and the pins can be removed.
  • Your child will follow up in the Orthopedic Clinic for further x-rays and treatment.

Pain control

  • Rest - No sports, gym, or other activities until cleared by your child’s practitioner.
  • Ice - Place an ice pack directly onto the cast over the fracture for the first 48 to 72 hours.
  • Elevation – Keep the elbow above the heart level for 48 hours after the cast is put on. When your child is lying down, rest the arm on enough pillows to lift hand above the level of the heart.
  • Your child should move his or her fingers often to help blood flow to the fingers.
  • Pain relievers, such as Motrin® or Tylenol®:Motrin® helps reduce pain and swelling; Tylenol® may also help with discomfort.Motrin can often be taken every six hours and Tylenol can be taken every four hours. These medicines can be alternated every three hours as needed for pain control.

Cast or splint care

After your child’s cast or splint is placed, it should stay clean and dry.  Do not place anything into the cast.  Refer to Helping Hand HH-II-2, Cast and Splint Care.

Your child will need to wear a collar and cuff (sling device) while the cast or splint is on.  This collar and cuff should only be removed to bathe.  Check the back of your child’s neck every day to make sure the collar and cuff is not rubbing and causing skin breakdown.  See Helping Hand HH-IV-147, Collar and Cuff

Expectations for recovery

Supracondylar humerus fractures often heal within 4 weeks from start of treatment (either surgery or casting).  After your child has his or her cast removed, it may take 4 weeks for the child to be able to move the elbow normally.  In rare cases, your child may require physical therapy to help regain strength and motion.  Your child’s practitioner will decide when the elbow strength and motion is normal and when your child can safely return to all activities.  This is typically around 8 weeks after injury.  

When to call the doctor

If any of these things happens after you leave the hospital, call your child’s orthopedic doctor or return to the Emergency Room:  

  • Your child has numbness or tingling in the fingers.
  • Your child’s fingers are bluish-purple in color or fingers feel cold and this does not improve with elevation.
  • Fingers do not become pink again within three seconds of pressing the fingernails. See Helping Hand HH-II-60, Circulation Checks.
  • More than a little swelling with discomfort
  • Your child is in too much pain to move his or her fingers
  • Fever higher than 101° F by mouth
  • Chills
  • Nausea or vomiting

Supracondylar Humerus Fracture (PDF)

HH-I-301, 2/09 Revised 2/18 Copyright 2009, Nationwide Children’s Hospital