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# Supracondylar humerus fracture

A supracondylar [humerus](https://durgical.com/en/anatomy/humerus/) fracture is a break just above the elbow, the most common elbow fracture in children; it can injure the artery and nerves nearby.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Humerus](https://durgical.com/en/anatomy/humerus/)
- [Brachial artery](https://durgical.com/en/anatomy/brachial-artery/)
- [Median nerve](https://durgical.com/en/anatomy/median-nerve/)
- [Anterior interosseous nerve](https://durgical.com/en/anatomy/anterior-interosseous-nerve/)
- [Radial nerve](https://durgical.com/en/anatomy/radial-nerve/)
- [Ulnar nerve](https://durgical.com/en/anatomy/ulnar-nerve/)
- [Brachialis](https://durgical.com/en/anatomy/brachialis/)
- [Elbow capsule](https://durgical.com/en/anatomy/elbow-joint-capsule/)
- [FDP](https://durgical.com/en/anatomy/flexor-digitorum-profundus/)
- [FPL](https://durgical.com/en/anatomy/flexor-pollicis-longus/)

## In the clinical exam

- [Compartment syndrome: the early signs](https://durgical.com/en/clinical-exam/compartment-syndrome-the-early-signs/)

## Why it happens

- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

Fracture of the distal humerus just above the condyles, the most common elbow fracture in children. Most are extension type, and the displaced fragment can injure the [brachial artery](https://durgical.com/en/anatomy/brachial-artery/) and median or [anterior interosseous nerve](https://durgical.com/en/anatomy/anterior-interosseous-nerve/).

## Who gets it

Mainly young children, typically between about 5 and 7 years, from falls from playground equipment, beds, trees or bicycles. It is a frequent paediatric orthopaedic emergency in Colombian hospitals.

## Causes

- Fall on an outstretched hand with the elbow hyperextended (extension type, by far the most common)
- Fall directly on a flexed elbow (flexion type, uncommon)

## Risk factors

- Age of about 5 to 7 years
- Falls from heights: playground equipment, trampolines, bunk beds, trees
- Ligamentous laxity allowing elbow hyperextension in children

## Pathophysiology

In a child the thin supracondylar bone, between the olecranon and coronoid fossae, is weaker than the ligaments. In hyperextension the olecranon levers into its fossa and the humerus breaks; the distal fragment moves backwards and the sharp proximal end pushes forwards toward the brachial artery and [median nerve](https://durgical.com/en/anatomy/median-nerve/). Swelling can cause forearm compartment syndrome.

## Classification

- Extension type (most common) or flexion type
- Gartland (extension type): I non-displaced; II displaced with intact posterior cortex; III completely displaced; IV unstable in flexion and extension
- Posterolateral displacement threatens the brachial artery and median nerve; posteromedial threatens the [radial nerve](https://durgical.com/en/anatomy/radial-nerve/)

## Symptoms and signs

- Elbow pain, swelling and refusal to use the arm after a fall
- S-shaped deformity of the elbow in displaced fractures
- Arm held in extension or slight flexion
- Bruising or [skin](https://durgical.com/en/anatomy/skin/) puckering in front of the elbow (anterior spike)
- Loss of the OK sign (thumb and index flexion) if the anterior interosseous nerve is injured

## Red flags

- Pulseless hand: pale (white) needs urgent reduction; pink but pulseless needs close vascular monitoring
- Severe pain on passive finger extension, escalating analgesic needs or tense forearm: compartment syndrome
- Nerve deficit before or after reduction
- Skin puckering, tenting or an open wound
- Floating elbow (ipsilateral forearm fracture)

## Diagnosis

**Clinical**
Careful documented neurovascular examination before any treatment: radial pulse, capillary refill, hand colour, and anterior interosseous, median, radial and [ulnar nerve](https://durgical.com/en/anatomy/ulnar-nerve/) function.

**Tests**
Usually not needed; pulse oximetry or Doppler may support the vascular assessment.

**Imaging**
AP and lateral elbow X-rays: posterior fat pad sign, anterior humeral line not crossing the middle third of the capitellum, and Baumann angle; comparison views sometimes.

## Differential diagnosis

- Lateral condyle fracture of the humerus
- Medial epicondyle fracture
- Elbow dislocation
- Radial head subluxation (pulled elbow)
- Non-accidental injury in a young child

## Goal of treatment

Restore alignment and stable fixation, preserve circulation and nerve function, and prevent compartment syndrome, Volkmann contracture and cubitus varus.

## Treatment

**Acute**
Splinting in a comfortable position without forced flexion, analgesia, and repeated neurovascular checks; urgent reduction if the hand is pale and pulseless.

**Conservative**
Type I (and some stable type II) fractures: above-elbow cast for a few weeks.

**Surgical**
Displaced fractures: closed reduction and percutaneous pinning under anaesthesia; open reduction if irreducible or if the artery needs exploration.

**Follow-up**
Postoperative checks of circulation, nerve function and forearm compartment pressure signs.

## Complications

- Volkmann ischaemic contracture after untreated compartment syndrome
- Brachial artery injury
- Nerve palsy (anterior interosseous most often; also radial and ulnar, including iatrogenic ulnar injury from a medial pin)
- Cubitus varus (gunstock deformity) from malunion
- Elbow stiffness and pin-site infection

## Prognosis

With timely reduction and fixation most children recover full function, and most nerve injuries recover spontaneously. Missed compartment syndrome can cause permanent, disabling contracture of the forearm and hand.

## Prevention

- Supervision of young children on playground equipment and trampolines
- Safety rails on bunk beds

## Test yourself

Think of the answer, then tap the question to see it.

## Which nerve is most often injured in extension-type supracondylar fractures?

The anterior interosseous nerve, a branch of the median nerve: the child cannot make the OK sign.

## Which artery is at risk in a displaced supracondylar humerus fracture?

The brachial artery, pushed by the sharp proximal fragment in front of the elbow.

## What is Volkmann ischaemic contracture?

Fibrosis and shortening of necrotic forearm flexor muscles after untreated compartment syndrome, causing a clawed, flexed wrist and fingers.

## What does the Gartland classification describe?

Displacement of extension-type fractures: I non-displaced, II posterior cortex intact, III completely displaced.

## What deformity results from malunion of a supracondylar fracture?

Cubitus varus, also called gunstock deformity.

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## Related conditions

- [Elbow dislocation](https://durgical.com/en/conditions/elbow-dislocation/)
- [Radial head subluxation (pulled elbow)](https://durgical.com/en/conditions/radial-head-subluxation/)
- [Humeral shaft fracture](https://durgical.com/en/conditions/humeral-shaft-fracture/)
- [Volkmann ischaemic contracture](https://durgical.com/en/conditions/volkmann-ischaemic-contracture/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Supracondylar Humerus Fractures](https://www.ncbi.nlm.nih.gov/books/NBK560933/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/supracondylar-humerus-fracture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/supracondylar-humerus-fracture/