Fracture - Supracondylar (SC) fractures

General notes

Supracondylar (SC) fractures typically present as the following:

1. Suspected SC fractures

2. Obvious Grade I, II or III fractures

All these require NV examination at each visit and assessment of their cast/backslab

Suspected Supracondylar(SC) fractures

• Place in above elbow backslab

First appointment

• 10-14 days post injury with cast removal, x-ray and clinical examination

• Confirmed fractures go in to cast for 2 more weeks

Post-operative SC fractures

• Strictly followed up as per the operative note.

• Most require an x-ray through the backslab at 7-10 days to check for any loss of position.

• Backslabs overwrapped or new casts applied only if required (eg in less extension)

• Routine removal of the cast/backslab is not necessary until time for wire removal at 3-4 weeks. The exact timing is dictated by the operating surgeon in the operative note. Most patients will be booked into a wire removal clinic prior to discharge from the hospital.

At wire removal:

• pre-removal radiograph

• Advice re: pin sites until healed

Advise that ROM can take up to 12-18 months to fully return to normal.

No routine checks beyond wire removal unless clinical concern.

Type I SC Fracture

Image reproduced with permission from RCH Melbourne: 
http://www.rch.org.au/clinicalguide/guideline_index/fractures/Supracondylar_fracture_of_the_humerus_Emergency_Department/

• Place in above elbow backslab

First appointment

• 7 days post injury for x-ray through backslab

• Backslab overwrapped in clinic

Type II SC Fracture

Image reproduced with permission from RCH Melbourne: 
http://www.rch.org.au/clinicalguide/guideline_index/fractures/Supracondylar_fracture_of_the_humerus_Emergency_Department/

Refer to on-call Orthopaedic Team

First appointment

• At 7 days post injury with x-ray of distal humerus in backslab

• Check for any loss of position

Fracture clinic review

• At 3 weeks post injury

• Removal of backslab and x-ray out of backslab

• Check for adequate callus

• Allow gentle Range of Motion (ROM)

• If there is any concern about the change in the carrying angle of the elbow (cubitus varus), longer follow-up with x-rays may be required

Discharge advice for family

• Return if any subsequent concern re deformity

• Likely to have prolonged period (months) of inability to fully extend elbow

• This does not cause functional disability and should not be treated with physiotherapy

Type III SC Fracture

Image reproduced with permission from RCH Melbourne: 
http://www.rch.org.au/clinicalguide/guideline_index/fractures/Supracondylar_fracture_of_the_humerus_Emergency_Department/

Refer to on-call Orthopaedic Team

First appointment

• Dependent on follow-up plan prescribed by Orthopaedic Consultant/Operative Surgeon

• Wires to be removed at wire removal clinic (booked prior to discharge from hospital)

Fracture clinic review

• If there is any concern about the change in the carrying angle of the elbow (cubitus varus/valgus), longer follow-up with x-rays may be required

Discharge advice for family

• Return if any subsequent concern re deformity

• Likely to have prolonged period (months) of inability to fully extend elbow

• This does not cause functional disability and should not be treated with physiotherapy

• Modify activities to avoid heavy arm use (eg climbing) for two months post-removal of cast