Elbow Case 3 ED Management

Supracondylar humerus fracture

ED management depends on the degree of displacement, swelling, and neurovascular status.

Nondisplaced fractures can be immobilized with the elbow flexed to 90 degrees. Pediatric fractures that are displaced with an intact posterior cortex can be managed by closed reduction and percutaneous fixation by the orthopedist. Open reduction is recommended when the fracture is open, not reducible by closed means, or has neurovascular compromise after closed reduction attempts. Orthopedics should be consulted to determine management of any displaced supracondylar fracture.

Because of the risk of compartment syndrome, many of these injuries require admission even after successful closed reduction for serial exams. The disposition of displaced fractures should be made in consultation with the orthopedist. Discharged patients require careful return instructions for signs of compartment syndrome. Malunion is another frequent complication.