Alabama Child Injuries Attorney

Understanding Supracondylar Fractures of the Elbow

When child pedestrians or cyclists are hit by motor vehicles, they instinctively put their arm or arms out to break the fall.  Notwithstanding protective gear, when the hand hits the ground at a high velocity, sudden and severe pain and injury can develop in the elbows even though the elbows may not strike the ground.  X-ray will often reveal a displaced or non-displaced supracondylar fracture as the cause of the pain and deformity. 

The humerus is the long thick bone in the upper arm, with the distal end at the elbow joint. At this distal end, there are two rounded bony knobs called condyles. The condyle attaches to other bones, tissues and muscles. In children whose bones are not yet fully developed, there is a small gap close to each end of the bone called a growth plate. A fracture of the humerus that occurs proximal to (right above) the condyle and the growth plate is termed a supracondylar fracture.

The lawyers at McAleer Law have helped families whose children have fractures and other orthopedic injuries at the hands of careless individuals and corporations.  Contact an Alabama personal injury lawyer at McAleer Law for assistance with your child injury claim. 

Supracondylar fractures are classified as either extension or flexion fractures, depending on the mechanism of injury and the displacement of the distal fragment.  98% of supracondylar fractures are of the extension type.

Extension (posteriorly displaced) supracondylar fractures occur as a consequence of a fall on the outstretched arm, when the elbow is either fully extended or hyperextended. The ground reaction produces a posterior moment of force at the elbow, fracturing the humerus in the supracondylar region and forcing the distal fragment posteriorly. The sharp distal end of the proximal fragment may project into the antecubital fossa, endangering the brachial artery and/or the median nerve. See Fig. 17-101. However, in most cases, the brachialis muscle protects the anterior neurovascular structures from injury.

Flexion (anteriorly displaced) supracondylar fractures are much rarer, accounting for only 2% of supracondylar fractures, and usually occur as a consequence of a direct blow on the flexed elbow. The force produces a posterior moment of force at the elbow, fracturing the humerus in the supracondylar region and forcing the distal fragment anteriorly. As the distal fragment displaces anteriorly, the periosteum (bony covering) is torn posteriorly.

Distal humeral fractures in adults are relatively uncommon injuries, representing only approximately 3% of all fractures in adults. Most of these adult injuries occur in a growing elderly population with osteoporotic bone.  This type of fracture is more commonly an injury of the immature skeleton, with a peak incidence at 5 to 10 years of age. It rarely occurs after the age of 15.

In the most common posteriorly displaced (extension) supracondylar fracture, the child usually presents holding the affected upper extremity immobile in extension. Typically an S-shaped deformity is obvious, along with tenderness and swelling in the region of the elbow. In anteriorly displaced (flexion) supracondylar fractures, the elbow is usually held in flexion.

Radiographically, these fractures can be classified into three types:

• Type I. Undisplaced or minimally displaced
• Type II: Incomplete fracture; anterior or posterior cortex intact
• Type III: Completely displaced; distal fragment migrates proximally and anteriorly or posteriorly

Given the risk of concomitant injury to the brachial artery and the median nerve, especially in the posteriorly displaced supracondylar fracture, a very thorough continual assessment and documentation of the neurovascular status is essential. The long-term consequences of missing a change in vascular or neurologic status can be devastating.  

Even after surgical repair, some clients have noted that the lateral aspect of the elbow remained swollen.  This might be the result of a deformity called a "cubitus varus" which is a complication of the supracondylar fracture.  Further, there may be tingling due to some tension or pressure on the ulnar nerve, as a result of the residual deformity.  In such a case, some patients receive a surgical procedure to correct the elbow deformity and to reduce the tension on the nerve.

If your child has suffered an injury in a fall or accident, contact a Mobile Child Injury Attorney at McAleer Law - 251-341-0116.