A fracture of the supracondylar region is a fracture that occurs at the lower end of the humerus bone (Latin: humerus), just above the elbow joint. Therefore, it is a fracture that usually does not involve the elbow joint itself (extra-articular fracture). It is the most common fracture among elbow fractures in children.
We classify these fractures into grades based on the degree of displacement of the fractured part from its original position: in grade 1, there is no displacement at all, in grade 2, there is partial displacement, and in grade 3, there is no contact at all between the fractured part and the main bone. This condition will affect the treatment decision. In grade 1, and sometimes in grade 2, a cast can be applied without surgery. In grade 3, we will always attempt to restore the fractured part to its place and fix it surgically.
This fracture occurs in an area where nerves, blood vessels, and growth centers of the bone are densely located. All of these can be affected during the fracture or surgery. However, such an injury is extremely rare. To assess such an injury, we repeatedly examine the child before and after the surgical procedure (or immobilization in a cast). If we identify any injury to blood vessels, nerves, or the bone's growth center, we will inform the parents and explain how to treat such an injury.
A suspected supracondylar fracture is likely when the injured child reports a direct fall on the elbow, such as falling from a bicycle or a high place. The elbow is very painful and swollen. Sometimes there is numbness in the fingers or another part of the hand. At this stage, it is advisable to immobilize the elbow to prevent movement and quickly go to a medical center. If it is difficult to immobilize the elbow, it is best to lay the child down and place the hand on the abdomen. It is recommended not to provide food or drink until receiving further instructions from medical staff.
When you arrive at the hospital, the child will undergo a general evaluation. At this stage, it is essential to inform the medical team about any previous medical issues (heart problems, breathing problems, allergies) or any other additional injuries that occurred during the incident (e.g., head, face, abdomen, or other limb injuries). X-rays will be taken, and based on the findings, we will propose the treatment. If surgical treatment is offered, we will explain in detail what is planned and ask you to sign a consent form for the surgery.
The surgery will be performed under general anesthesia. The anesthetist will meet with you at the entrance to the operating room, and you can talk to them before the surgery. After the child is asleep and does not feel any pain, we will use a portable X-ray machine to visualize the fracture and then return the fractured part to its place. Then we will insert two pins, about 1.5 mm in diameter, through the skin into the fracture to stabilize the fractured part in place. In exceptional cases, a skin incision may be necessary to align the fractured part properly. Once the fracture is stabilized, the hand will be splinted in a bent position.
In general, there is almost no pain after the fracture is stabilized, so there is no restriction for the child to get out of bed immediately after returning to the ward after the surgery. If, however, the child experiences pain, it is advisable to ask the nurse for pain relief. Most children are discharged to their homes the day after surgery.
Around 7-10 days after the initial treatment, we will schedule a follow-up appointment for the child. During the visit, we will remove the dressings and make sure the pins are in place and there are no signs of infection. We will check again that none of the previously described complications have occurred, and we will perform a follow-up X-ray to confirm that the fracture is well stabilized. If everything is fine, we will schedule another follow-up visit after about three weeks to remove the cast or pins.
This explanation is general and does not replace personalized explanations by the treating physician. For any questions, feel free to email Dr. Ehood Lebel at lebel@szmc.org.il.