Snapshot An 7-year-old girl falls from a jungle gym and lands on her outstretched left hand. She develops immediate-onset left elbow pain and swelling. On exam, her arm is held in 30 degrees of extension and she is unable to move her elbow due to pain. A radiograph is shown and demonstrate a dorsally displaced supracondylar humerus fracture. Introduction Clinical definition fracture of the distal humerus proximal to the medial and lateral condyles Epidemiology Incidence most common pediatric elbow fracture accounts for 41% of all serious pediatric elbow injuries extension type injury most common (95-98%) Demographics children aged 5-7 years of age rare in adults males and females equally likely Etiology Accidental trauma (e.g., fall from moderate height) fall on outstretched hand login to view 1 more bullet fall on posterior elbow login to view 1 more bullet Pathoanatomy normal anatomy login to view 4 more bullets fracture mechanics login to view 6 more bullets Salter Harris classification - if through a growth plate login to view 5 more bullets Associated conditions vascular login to view 1 more bullet neurapraxia login to view 8 more bullets Presentation Symptoms elbow pain and limited range of motion Physical exam inspection login to view 3 more bullets palpation login to view 1 more bullet motion login to view 1 more bullet neurologic exam login to view 5 more bullets vascular exam login to view 3 more bullets Imaging Radiographs indications login to view 1 more bullet findings login to view 7 more bullets Treatment Conservative long arm posterior splint followed by long arm casting login to view 3 more bullets Operative closed reduction and percutaneous pinning login to view 4 more bullets Differential Radial head subluxation (Nursemaid's elbow) second most common serious pediatric elbow injury arm held in flexion and pronation commonly occurs due to excessive traction, not a fall Lateral epicondyle fracture third most common serious pediatric elbow injury will be tender on lateral side with minimal tenderness on medial side Complications Malunion cubitus varus (gunstock deformity) login to view 2 more bullets Vascular injury Volkmann ischemic contracture login to view 2 more bullets Prognosis Favorable non-displaced or minimally displaced fractures Negative poor anatomic reduction vascular injury