A supracondylar fracture at the elbow is one of the most common broken bones in children. Most kids recover without any difficulty. However, there can be complications with this injury. Some of these complications can be very severe. Read on to learn more about supracondylar fractures. Let’s start with anatomy.
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone. It forms individual joints with the ulna and radius, which are the forearm bones. Movements of the elbow include flexion and extension. Flexion is when the forearm and upper arm come closer together (bending the elbow) and extension is when they are moved farther apart (straightening the elbow).
The upper parts of the radius and ulna will also form a joint called the radioulnar joint. This joint allows for the movements of pronation and supination. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
At the elbow, there are two big bony bumps on either side of the joint. These are the epicondyles at the end of the humerus. Epicondyles are large bony bumps where the tendons of muscles and ligaments attach. There is a lateral epicondyle and a medial epicondyle. Above the epicondyles are the medial and lateral supracondylar ridges. In between the ridges is the supracondylar region. In children this area is weaker and thinner, and prone to fractures (breaks).
The supracondylar fracture
This is a fracture or break of the humerus in the supracondylar region. This means that the there was a break at the end of the upper arm bone near the elbow joint. This is the most common type of humeral fracture, and the second most common bony injury in children. This injury tends to occur between the ages of 5 to 8 years old when the supracondylar region is still undergoing skeletal maturity. A supracondylar fracture is usually caused by a fall from a height, sports, or a fall on an outstretched hand.
What are the symptoms of a supracondylar fracture?
There are several symptoms associated with a supracondylar fracture. These include:
- Pain in the elbow
- Swelling at the elbow, forearm, and hand
- Elbow or arm looks different from its usual shape
- Unable to move elbow because it hurts
- Numbness in the fingers or hand
- Cool or cold fingers and hand – could be turning blue
What some complications of a supracondylar fracture?
There are important blood vessels and nerves that pass through the supracondylar area. This means that these structures can be damaged during an injury. Potential associated injuries include:
- Soft tissue damage – This means damage to muscle, tendon, ligament, or skin.
- Additional fractures at the elbow – These could include fractures to the radius, ulna, or other areas of the humerus.
- Neurological injury – This could include the radial, ulnar, median, and anterior interosseous nerve. Changes in sensation and muscle strength/activation could be affected.
- Vascular compromise – The brachial artery could be injured which could lead to decreased blood flow to the forearm and hand. This is a surgical emergency.
- Compartment syndrome – This is a very serious condition that involves pressure buildup in the tissues. This can cause decreased blood flow and damage to the nerve and muscles.
Will my child need surgery?
The answer is possibly. If the fracture is non-displaced (meaning that the bones have not moved), then a cast is applied for 3-4 weeks. If the fracture is displaced, then surgery will be needed so that the bones can heal in the proper position.
Who should we see?
- Physician – If you suspect that you or your child sustained a supracondylar fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this could be an extremely serious condition. However, if your fracture has already been treated and you suspect additional injury, then it would be best to see your orthopedist, pediatrician, or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy might be needed if you or your child are having difficulty regaining strength and/or motion around the elbow. Kids usually do not need therapy because they tend to perform their own therapy by playing. My son broke his radius and ulna at the wrist when he was 5. He was able to regain full function and motion with little help from me. However, if you are an adult and suffered this type of fracture, then physical therapy could be very beneficial. Your PT can evaluate you to determine the extent of your deficits and use manual therapy, as well as, stretching, and strengthening to help address all problems in and around the elbow.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking, or jogging while your elbow is healing.
- Ice – Ice can help decrease pain and symptoms at the elbow. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- The following are activities that you (or your child) can do after the cast is removed or you are cleared by your surgeon.
- Soft tissue mobilization – This is really only for adults. Kids tissue heals so quickly, that it does not need any manipulation. However, for adults, soft tissue mobilization helps release the muscles around the elbow and decreases the tension on the tendon. Use a massage ball, lacrosse ball, tennis ball, or your own fingers to massage painful areas all around the elbow. Spend a good 3 to 5 minutes rolling. Do not roll so hard that you bruise the area, but it should be a pretty painful sensation. Roll out the area no more than a few times a week. See the video below.
-
-
- Elbow stretches – The elbow might have limited motion in certain directions. Typically, extension or straightening the elbow is the hardest to fully regain. However, depending on the person, then flexion, pronation, or supination might also be tight. See the video below in how to stretch the muscles around the elbow.
-
-
-
- Wrist flexion and extension stretching – You can also need to stretch out the wrist flexors and extensors. These muscles attach at or near the elbow and could be tight. See the video below.
-
-
-
- Strengthening the muscles around the elbow and wrist – Strengthening the muscles around the wrist and elbow are also important in being able to return to your activity. Decrease your resistance or number of repetitions if the pain is moderate to severe during the exercise or returns after the exercise. Using dumbbells or resistance bands can increase strength and difficulty. See the video below.
-
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- Movements of the elbow include flexion and extension.
- The upper parts of the radius and ulna will also form a joint which allows for the movements of pronation and supination.
- Above the epicondyles are the medial and lateral supracondylar ridges.
- In between the ridges is the supracondylar region.
- In children this area is weaker and thinner, and prone to fractures (breaks).
- This injury tends to occur between the ages of 5 to 8 years old when the supracondylar region is still undergoing skeletal maturity.
- This is a fracture or break of the humerus in the supracondylar region.
- Swelling, pain, and difficulty moving the elbow are symptoms of a supracondylar fracture.
- There can be serious complications so it is important to seek medical help when a fracture is suspected.
- Physical therapy will play a role if there is difficulty in regaining strength and mobility in the elbow.
- There are things you can do once the cast is off or you are cleared by the surgeon.
- Ice
- Soft tissue mobilization
- Elbow stretches
- Wrist stretches
- Strengthening of the muscles around the elbow and wrist
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Supracondylar_Humeral_Fracture
https://www.ncbi.nlm.nih.gov/books/NBK560933/