Dr. Mostafa Azab
Lecturer of Orthopedic Surgery
Supracondylar Fracture of the
Is a fracture, usually of the
, although it mayepicondyles
occur elsewhere. While
relatively rare in adults it is
one of the most common
fractures to occur in
children and is often
associated with the
development of serious
There are three types based on the degree of
separationof the fractured fragments:
1-Type I: undisplaced or minimally displaced fractures.
2-Type II: partially displaced.
3-Type III: fully displaced.
1-This is the most common elbow fracture in children.
2-About 60% of fractures in children.
3-It is most common in children <10.
4- Peak incidence is between the ages of 5-8 years of age.
5-Primarily in children who are around age 7 years.
The child presents with history of a falling on an
outstretched hand .
Followed by pain, swelling and inability to move the
On examination: Unusual prominence of olecranon
process but because it is a supracondylar fracture, the
three bony point relationship is maintained, as in a
Lateral Humeral Condyle Fractures
Lateral condyle fractures
are common and their
outcomes have historically
been worse than
articular nature, and
missed diagnosis lead to
an unacceptably high
incidence of malunion
Epidemiology & Types:
6 Years old is the
Type I: SH Type IV
TypeII: SH TypeII
According to Displacement:
Classification based on
<2mm, indicating intact
4mm, displaced joint
displacement >4mm, joint
displaced and rotated
Exam may lack the obvious deformity often seen with
Swelling and tenderness are usually limited to the lateral side.
If the lateral condyle and capitellum have not ossified then
radiographic findings can be subtle.
Contra-lateral radiographs are very important.
MRI and arthrograms can be helpful as well
best judge if intra-articular incongruity.
long arm casting:
Only indicated if < 2 mm of displacement, which indicates the cartilaginous hinge is most likely
follow patient very closely (every 4-5 days)
closed reduction achieves adequate reduction with no evidence of intra-articular incongruity
Divergent pin configuration most stable
open reduction and percutaneous pinning
if > 2mm of displacement
any joint incongruity
Kocher lateral approach used
avoid dissection of posterior aspect of lateral condyle (source of vascularization)
intraoperative arthrograms are valuable to delineate the fracture and ensure anatomic reduction
1-Lateral overgrowth bump
posterior dissection can result in lateral condyle
caused from delay in diagnosis and improper treatment
may result in cubitus valgus and tardy ulnar nerve palsy
REQUIRES ORPEAK AGE% ELBOW
AND NECK #
Salter Harris Classification
I – S = Slip (separated or
straight across). Fracture of
the cartilage of the physis
II – A = Above. The fracture lies
above the physis, or Away
from the joint.
III – L = Lower. The fracture is
below the physis in the
IV – T = Through. The fracture
is through the
metaphysis, physis, and
V – R = Rammed (crushed).
The physis has been crushed.