The young child may present with vague pain so that the differential diagnosis may include nursemaid's elbow, occult fractures of the radial head, condyle fractures or a septic joint. Children with supracondylar extension fractures may have a prominent olecranon with the distal humeral fragment palpated posteriorly and superiorly because of the pull of the posterior tricep muscle. Patients with a supracondylar flexion fracture may carry their elbow flexed with loss of the olecranon prominence. The anterior humeral line on the lateral elbow radiograph intersects the posterior two thirds of the capitellum. I Minimal or no displacement - Stable fractures which require splinting of elbow at 90 degrees for child's comfort.
Complications are rare.
Type II Angulated fractures which are not completely displaced The extremity needs immobilization with a posterior long arm splint from the axilla to the metacarpal heads. The child should be hospitalized for potential neurovascular compromise. These fractures require immediate orthopedic referral as the potential for neurovascular injuries and compartment syndromes is the greatest. Fractures associated with limb-threatening vascular compromise should be reduced by the experienced emergency physician only when emergent orthopedic consultation is not available. Initial orthopedic approaches includes closed reduction followed by percutaneous pin fixation or open reduction if the previous measures were unsuccessful.