Supracondylar Fractures

The procedure for the management of paediatric supracondylar fractures includes:

Analgesia

Initial assessment should include provision of analgesia and a search for associated neurovascular complications.

Intranasal administration of analgesia (diamorphine) is a useful option in children and can delay attempts at intravenous access until topical anaesthesia has taken effect.

Treatment

Undisplaced fractures may be treated with a collar and cuff and can be followed up in fracture clinic. If there is significant pain, a back slab may be a better option.

Displaced fractures should all be referred for manipulation, urgently if circulation is compromised.

Complications

Complications include:

  • Cubitus varus (gun stock deformity)
  • Malunion and stiffness
  • Myositis ossificans
  • Nerve injury (most commonly the median nerve)
  • Brachial artery (due to stretch and posterior displacement)
  • Volkmann’s ischaemic contracture (due to compartment swelling)