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Epicondylar fracture: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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ICD-10 code
S42.4. Fracture of the lower end of the humerus.
Supracondylar fractures include fractures with a fracture line that runs distal to the body of the humerus, but without disruption of the intra-articular portion of the condyle.
What causes a supracondylar fracture?
A flexion fracture occurs when you fall on an arm bent at the elbow joint.
An extension fracture occurs when a person falls on an arm that is extended at the elbow joint.
Symptoms of a supracondylar fracture
Following the injury, pain and dysfunction of the limb appear.
Diagnosis of supracondylar fracture
Anamnesis
The anamnesis shows a corresponding injury.
Inspection and physical examination
When attempting active and passive movements, crepitus may be felt by the patient or examiner. The elbow joint is deformed and significantly swollen. The triangle and Huther's line are preserved. Marx's sign is impaired - the angle between the median longitudinal axis of the humerus and the horizontal line connecting both epicondyles is changed. Normally, the angle is 90°.
Laboratory and instrumental studies
Flexion fracture. Radiographs of the distal end of the humerus in two projections reveal a fracture. The fracture line runs above the condyle obliquely from below and behind, forward and upward. The central fragment is displaced backward and inward, the peripheral fragment is displaced forward and outward. The angle between the fragments is open forward and inward.
Extension fracture. On the radiograph, with the same level of damage, the displacement of the fragments will be different. The peripheral fragment is displaced backwards and outwards, the central one - forwards and inwards. The fracture line goes from the front and bottom to the top and back. The flexors of the forearm press the peripheral fragment to the central one. The shoulder muscles displace the fragments lengthwise.
Treatment of supracondylar fracture
Conservative treatment of supracondylar fracture
Treatment of a flexion supracondylar fracture of the humerus involves local or general anesthesia and closed manual repositioning. Traction is applied along the longitudinal axis of the limb, and the peripheral fragment is displaced posteriorly and inward. Repositioning is performed with the limb extended at the elbow joint. After matching the fragments, the forearm is bent at an angle of 90-100° and fixed with a Turner splint for 6-8 weeks, then the splint is made removable and left in place for another 3-4 weeks.
Extension fracture. After anesthesia, manual reposition is performed. The limb is bent at the elbow joint at a right angle to relax the muscles and traction is performed along the longitudinal axis. The peripheral fragment is displaced forward and inward. A Turner splint is applied to the arm bent at the elbow joint at an angle of 60-70°. Control radiography is performed. The immobilization period is the same as for a flexion fracture.
If repositioning is unsuccessful, skeletal traction is applied to the olecranon on an abduction splint for 3-4 weeks. Then a plaster cast is applied. It should be remembered that during the traction period, the limb should be bent at the elbow joint at an angle of 90-100° for a flexion fracture, and at an angle of 60-70° for an extension fracture.
Instead of skeletal traction, an external fixation device can be used for staged repositioning and subsequent retention of fragments.
Surgical treatment of supracondylar fracture
Surgical treatment of supracondylar fractures is performed in cases where all attempts to align the fragments have been unsuccessful. Open reposition is completed by fastening the fragments with plates, bolts and other devices. A plaster cast is applied for 6 weeks, then removable immobilization is prescribed for another 2-3 weeks.
Approximate period of incapacity
Working capacity after conservative and surgical treatment of supracondylar fractures of the humerus is restored within 10-12 weeks.
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