Sections

Presentation

Complications

Cubitus varus

The most common complication for supracondylar fractures are cubitus varus or "gunstock deformity", which is a loss of the carrying angle and results in more of a cosmetic disability rather than a functional disability (see the image below).

Cubitus varus.

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Volkmann ischemia

This is a form of compartment syndrome that can lead to muscle ischemia and permanent muscle contracture, particularly occurring in children. Symptoms suggestive of this complication include pain with passive extension of the fingers, refusal to open the hand, and forearm tenderness.

Median nerve injury

Displaced supracondylar humerus fractures may lead to median nerve dysfunction. Rarely does this result in complete nerve transection, and full return of function is common.

Malunion

Angulated or displaced fractures that remain unreduced lead to functional and cosmetic deformities.

Radial head fracture

Nondisplaced fractures that are immobilized for prolonged periods of time may have permanently decreased range of motion.

Comminuted radial head fractures associated with undiagnosed distal radial-ulnar joint injuries can lead to permanent wrist injuries and loss of pronation/supination motion.

Olecranon fracture

An ulnar nerve injury, although rare, may be associated with a displaced olecranon fracture.

Differential Diagnoses

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Media Gallery

Intercondylar fracture.
Supracondylar fracture.
Displaced supracondylar fracture.
Medial epicondyle fracture.
Lateral condyle fracture.
Radial head fracture.
Olecranon fracture.
Anterior and posterior fat pads with radial head fracture.
Cubitus varus.

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Author

Daniel K Nishijima, MD, MAS Professor of Emergency Medicine, Vice Chair of Research, Department of Emergency Medicine, University of California, Davis, School of Medicine

Daniel K Nishijima, MD, MAS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew Goldman, MD Associate Medical Director, Department of Emergency Medicine, Southside Hospital, NS-LIJ

Matthew Goldman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Ossification Centers	Age of Appearance, y
Capitellum	1-2
Radial head	4-5
Internal (medial) epicondyle	4-5
Trochlea	8-10
Olecranon	8-9
External (lateral) epicondyle	10-11

Elbow Fracture in the ED Clinical Presentation

Complications

Cubitus varus

Volkmann ischemia

Median nerve injury

Malunion

Radial head fracture

Olecranon fracture

References

Tables

Contributor Information and Disclosures

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