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.
- Test anterior interosseous function with an OK sign, median with thumb opposition, radial with wrist or finger extension and ulnar with finger abduction.
- Obtain AP and true lateral elbow radiographs including distal humerus; review anterior humeral line, Baumann angle and radiocapitellar alignment.
- Splint near a safe comfortable angle without forcing flexion in a swollen or poorly perfused limb and repeat the examination after splintage.
- Displaced Gartland II or III injuries generally require urgent reduction and percutaneous-wire stabilisation by an experienced paediatric team.
- A pale pulseless hand requires immediate reduction; a persistently perfused pulseless hand follows a closely monitored senior vascular decision pathway.
- Provide parent instructions for escalating pain, tight cast, colour change, numbness, fever or inability to move fingers.
Key red flags
A pale cool pulseless hand requires emergency reduction and vascular assessment; prolonged diagnostic delay is unsafe.
A pink pulseless hand still needs urgent senior management, repeated objective perfusion review and a documented exploration threshold.
Escalating pain, anxiety, analgesic requirement, pain on passive finger stretch or progressive deficit suggests compartment syndrome.
Skin puckering, anterior bruising, open injury or gross displacement indicates severe soft-tissue tethering and urgent theatre care.
Pain, swelling and S-shaped elbow deformity follow a fall on the outstretched hand.
Cool pallor, delayed refill and absent pulse indicates critical perfusion and mandates emergency reduction.
Warm colour and refill with no palpable pulse implies collateral flow but still needs urgent monitored specialist care.
Inability to flex thumb interphalangeal and index distal joints prevents a round OK sign.
Increasing pain, passive finger stretch pain and progressive motor or sensory change requires immediate escalation.
Investigation priorities
Define displacement, rotation, columns and alignment while excluding other paediatric elbow fracture.
Management branches
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.
- Obtain radiographs, splint safely, keep fasting and call paediatric orthopaedics for displaced or abnormal-perfusion injury.