Supracondylar fractures of the humerus are most common in children, accounting for 30-40% of elbow fractures in children, with the peak incidence occurring between the ages of 5 and 12. Improper early management can easily lead to ischemic contracture, while advanced stages may result in deformities such as cubitus varus.

bubble_chart Etiology

1. Extension type

is the most common, accounting for more than 90%. When falling, the elbow joint is in a semi-flexed or extended position, with the palm landing on the ground. The force is transmitted along the forearm to the lower end of the humerus, pushing the humeral condyle backward, while gravity pushes the humeral shaft forward, resulting in a humerus supracondylar fracture. The fracture line runs obliquely from the anterior inferior to the posterior superior, with the distal end of the fracture displaced backward and upward, and the proximal end displaced forward and downward. In severe cases, it may injure the median nerve and the brachial artery. Based on the lateral displacement of the fracture, it can be further divided into ulnar deviation type and radial deviation type. Among them, the incidence of cubitus varus in ulnar deviation fractures can be as high as 74%.

2. Flexion type

is relatively rare, accounting for about 5%. When falling with the elbow joint in a flexed position, the force impacts the olecranon from the posterior direction upward, causing the distal end of the supracondylar fracture to displace forward. The fracture line runs obliquely from the posterior inferior to the anterior superior.

bubble_chart Diagnosis

History of obvious trauma, pain in the affected limb, and limited mobility. X-rays can confirm the diagnosis and classify the fracture, such as upper arm shortening, normal forearm, normal upper arm, or forearm shortening type.

1. Greenstick fracture

The fracture end is not displaced. If the anterior tilt angle disappears, no reduction is needed. If the anterior tilt angle increases, perform gentle manual reduction under brachial plexus anesthesia or general anesthesia, and fix with a long-arm cast in the functional position for 3–4 weeks. 2. Displaced fracture

Perform manual reduction under brachial plexus or general anesthesia, and fix with a long-arm cast for 4–6 weeks. The key points of manual reduction are: first, longitudinal traction to correct overlapping displacement; then, lateral compression to correct lateral displacement; finally, correct anteroposterior displacement. Radial lateral displacement does not need to be fully corrected, but ulnar lateral displacement should be overcorrected to avoid cubitus varus deformity. For flexion-type fractures, fix in a semi-extended position after reduction. For extension-type fractures, fix in a position of less than 90° flexion after reduction, ensuring fracture stability without compromising hand circulation. If flexion affects circulation but slight extension leads to instability, percutaneous Kirschner wire cross-fixation under fluoroscopic guidance can be performed, followed by external fixation with a cast in an appropriate flexion position. Alternatively, traction therapy can be applied, followed by cast immobilization after swelling subsides. 3. Traction therapy

Applicable for fractures older than 24–48 hours, with severe soft tissue swelling, blister formation, inability to perform manual reduction, or unstable fractures after reduction. 4. Open reduction

Indicated for cases of failed manual reduction, open fractures, fractures combined with vascular injury, nonunion, or severe malunion with cubitus varus/valgus deformity, where osteotomy may be performed for correction. 5. Fracture combined with nerve injury

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Early diagnosis and prevention are crucial. For patients presenting with the 5 "P" signs, first reduce the fracture and relieve compression factors. If no improvement occurs, perform early vascular exploration and repair, and if necessary, perform fasciotomy for compartment decompression.

bubble_chart Complications

Ischemic contracture

bubble_chart Differentiation

Key points for differentiating between humerus supracondylar fracture and elbow dislocation

1. Humerus supracondylar fracture (extension type)

Partial movement of the elbow joint is possible

No change in the posterior elbow triangle

Shortened upper arm, normal forearm

2. Elbow dislocation

Elastic fixation of the elbow joint

Change in the posterior elbow triangle

Normal upper arm, shortened forearm