Injuries > Elbow & Forearm > Supracondylar Fracture
(Also known as a Fractured Humerus, Broken Humerus)
What is a supracondylar fracture?
A supracondylar fracture is a condition characterized by a break in the upper arm bone (humerus – figure 1) just above the elbow joint.
Figure 1 – Relevant Anatomy for a Supracondylar Fracture
The elbow joint comprises the union of 3 long bones: the humerus (upper arm bone), the ulna and the radius (lower arm bones) (figure 1). The humerus has two bony prominences known as the epicondyles situated at the inner and outer aspect of the elbow. Just above the epicondyles is a region of the humerus bone known as the supracondylar region (figure 2).
During certain activities, such as a fall onto the outstretched hand, stress is placed on the humerus bone and supracondylar region. When this stress is traumatic and beyond what the bone can withstand a break in the humerus in the supracondylar region may occur. This condition is known as a supracondylar fracture.
A supracondylar fracture is more common in children than in adults. Often a humerus fracture occurs in combination with other injuries such as a sprained or dislocated elbow or other fractures of the upper limb.
Supracondylar fractures can vary in location, severity and type including, displaced fracture, un-displaced fracture, greenstick, comminuted etc.
Causes of a supracondylar fracture
A supracondylar fracture most commonly occurs due to a traumatic weight bearing force through an outstretched arm such as a fall from a height or bicycle. They may also occur due to a direct blow to the elbow or arm from a moving object or due to collision with a stationary object (such as road / traffic accidents or contact sports).
Signs and symptoms of a supracondylar fracture
Patients with a supracondylar fracture typically experience a sudden onset of sharp, intense elbow or upper arm pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the injury. Pain can occasionally settle quickly leaving patients with an ache at the site of injury that is particularly prominent at night or first thing in the morning. Patients with this condition may also experience swelling, bruising and pain on firmly touching the affected region of the bone. Pain may also increase during certain movements of the elbow, wrist or shoulder or during weight-bearing activity (such as pushing) through the affected arm. Pins and needles or numbness may also be present in the elbow, forearm, hand or fingers. In severe supracondylar fractures (with bony displacement), an obvious deformity may be detected.
Diagnosis of a supracondylar fracture
A thorough subjective and objective examination from a physiotherapist or doctor is essential to assist with diagnosis of a supracondylar fracture. An X-ray is required to confirm diagnosis. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of injury.
Treatment for a supracondylar fracture
Because supracondylar fractures are rotationally unstable and have a high rate of neurovascular complications, they should be considered an orthopedic emergency. For those fractures that are displaced, unstable or cannot be reduced without jeopardizing the blood supply, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic) followed by surgical external or internal fixation to stabilize the fracture (e.g. using pins). This may be followed by the use of a splint, plaster cast, sling or brace for a number of weeks.
For those isolated supracondylar fractures that are not displaced treatment typically involves immobilization either via external or internal fixation, a splint or plaster cast for approximately 4 – 6 weeks.
The orthopedic surgeon will determine the most suitable treatment for the fracture based on a number of factors such as the location, type and severity of the fracture.
Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can generally begin as guided by the treating physiotherapist.
One of the most important components of rehabilitation following a supracondylar fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the humerus should also be avoided particularly lifting, weight bearing or pushing activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to cause further damage and may slow healing or prevent healing of the fracture altogether.
Patients with a supracondylar fracture should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with immobilization. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.
Prognosis of a supracondylar fracture
Patients with a supracondylar fracture usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.
Physiotherapy for a supracondylar fracture
Physiotherapy treatment is vital in all patients with a supracondylar fracture to hasten healing and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- electrotherapy (e.g. ultrasound)
- taping or bracing
- exercises to improve strength and flexibility
- activity modification
- a graduated return to activity plan
Other intervention for a supracondylar fracture
Despite appropriate physiotherapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. Occasionally, patients who are initially managed conservatively may require surgery to stabilize the fracture and a bone graft to aid fracture healing.
Exercises for a supracondylar fracture
The following exercises are commonly prescribed to patients with a supracondylar fracture following confirmation that the fracture has healed, and that the orthopaedic specialist has indicated it is safe to begin mobilization. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Elbow Bend to Straighten
Bend and straighten your elbow as far as possible pain free (figure 3). Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.
Figure 3 – Elbow Bend to Straighten (left side)
Begin this exercise with your elbow at your side and bent to 90 degrees (figure 4). Slowly rotate your palm up and down as far as possible pain free. Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.
Figure 4 – Forearm Rotations (right side)
Tennis Ball Squeeze
Begin this exercise holding a tennis ball (figure 5). Squeeze the tennis ball as hard as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times.
Figure 5 – Tennis Ball Squeeze (right hand)
Physiotherapy products for a supracondylar fracture
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with a supracondylar fracture include:
To purchase physiotherapy products for a supracondylar fracture click on one of the above links or visit the PhysioAdvisor Shop.
Find a Physio for a supracondylar fracture
Find a Physiotherapist in your local area who can treat a supracondylar fracture.
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