A supracondylar fracture is a break just above the elbow, and it’s the most common elbow fracture in children, usually from a fall onto an outstretched hand off monkey bars, a trampoline or a bed.
It needs the EMERGENCY DEPARTMENT the same day.
Mild, undisplaced breaks are treated in a cast for about three to four weeks. Displaced breaks are usually straightened under anesthetic and held with pins.
The things doctors watch most closely are the nerves and blood supply to the hand, and pain that keeps rising, which can signal dangerous pressure in the forearm.
What it looks like
- Severe pain at the elbow after a fall
- Swelling, sometimes rapid, and often bruising
- The child holds the arm still and won’t bend or straighten the elbow
- In more displaced fractures, the elbow looks out of shape
A child who suddenly won’t use an arm after a pull, with no fall and no swelling, may have a pulled elbow instead. A fall with swelling needs an X-ray.
After an elbow fracture, pain that keeps climbing is never something to wait out overnight.
Before you get to the hospital
- Support the arm in the position the child finds most comfortable. Don’t try to straighten it
- A simple sling or a pillow in the lap helps
- Take off rings and bracelets
- Don’t give food or drink in case surgery is needed, unless advised otherwise
The checks that matter
- Nerves: the fracture can bruise nerves. The most commonly affected stops the child making an “OK” sign with the thumb and index finger. Most nerve injuries recover over weeks to months. See AIN palsy
- Blood supply: a cold, pale or white hand is an emergency
- Compartment syndrome: pain out of proportion, pain when the fingers are gently straightened, a tight forearm, and needing more and more pain relief. Emergency. See forearm compartment syndrome
Treatment and recovery
- Undisplaced: above-elbow cast or splint for around three to four weeks. See posterior elbow resting splint
- Displaced: straightened under general anesthetic and held with pins through the skin, then a cast for three to four weeks
- Pin removal: usually in clinic at around three to four weeks, quick and often without anesthetic. See K-wires
- After the cast: the elbow is stiff at first. Most children regain movement through play over the following weeks to months without formal therapy
- Return to sport and climbing: usually around six to eight weeks after the injury, as advised
What’s normal after the cast
- A stiff elbow that can’t fully straighten for a few weeks
- Guarding the arm at first, then forgetting about it in play
- Improvement week on week
Don’t force the elbow straight with stretches. Gentle, active play is the best therapy. See elbow anatomy for why the elbow stiffens.
Go back the same day if
- Pain is increasing, especially despite pain relief
- It hurts to gently straighten the fingers
- The hand is cold, pale, blue or numb
- The cast feels tight or the fingers are very swollen
- Pin sites are red, swollen or discharging
Get it reviewed if
- The elbow is still very stiff three months after the cast came off
- The arm looks angled when straightened, compared with the other side
- Weakness or numbness in the hand hasn’t improved
Emergency department today, watch the pain and the fingers closely, and let play bring the elbow back.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.