Pediatric emergency medicine trisk 3452 3452
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hyperextension load on the elbow. The extension supracondylar fracture accounts
for 95% of these injuries and is often described using the Gartland classification
system ( Table 111.5 ). Less commonly, a direct fall onto the flexed elbow results
in an anterior displacement of the distal fragment. The FOOSH mechanism
causes the ulna and triceps muscles to exert an unopposed force on the distal
humerus, causing failure of the anterior periosteum and, in more severe injuries,
extending to and through the posterior cortex. This progression results in a
posterior displacement of the condylar complex. Displacement of the fracture
increases the risk of injury to the brachial artery and the median, radial, and ulnar
nerves as the neurovascular bundles are stretched and/or disrupted. Obesity in
childhood and adolescence reduces bone mineral density with an increased
propensity for fractures. This can be associated with more complex supracondylar
humeral fractures, preoperative and postoperative nerve palsies, and postoperative
complications.
FIGURE 111.15 A: Anteroposterior radiograph of a normal elbow of a child. B: Normal lateral
radiograph.
Clinical Considerations
Clinical recognition . A child with a supracondylar fracture often presents to the
ED holding the arm straight in pronation and refusing to use the arm or flex at the
elbow. Supracondylar fractures occur most commonly between 3 and 10 years
