Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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A pulseless or tense elbow threatens the limb
Displaced distal humerus can kink the brachial artery and injure nerves; severe swelling, skin puckering and compartment pressure can progress to ischaemic contracture.
Action: Give analgesia, remove constriction, keep the child fasting, document hand perfusion and individual nerve functions, align and splint without excessive flexion, and obtain immediate paediatric orthopaedic review for urgent reduction and stabilisation.
Synopsis
Recognise the common paediatric extension-type supracondylar fracture, document perfusion and median, anterior interosseous, radial and ulnar function, and expedite safe reduction and fixation when displaced.
Supracondylar fracture is common around ages 5 to 8 after a fall on an outstretched hand and is usually extension type.
Inspect swelling, bruising, skin puckering and wounds and remove rings or constricting items promptly.
Document hand colour, temperature, capillary refill, radial pulse and Doppler when needed, not only whether a pulse is palpable.
Key red flags
A pale cool pulseless hand requires emergency reduction and vascular assessment; prolonged diagnostic delay is unsafe.
Extension fracture
Pain, swelling and S-shaped elbow deformity follow a fall on the outstretched hand.
Investigation priorities
01
AP and true lateral elbow radiographsFirst step
Define displacement, rotation, columns and alignment while excluding other paediatric elbow fracture.
Management branches
Emergency assessmentDocument and protect the hand
A child presents with a swollen painful elbow after a fall.
Give age-appropriate analgesia, inspect skin and remove external constriction.
Record colour, warmth, refill, pulse and four named nerve functions before splintage.
Key medicines
Paracetamol for a child with fracture painFor children, prescribe the current BNF for Children weight- or age-based paracetamol dose and interval, recording weight and avoiding duplicate combination products.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.