The commonest elbow fracture in children, usually extension-type after a fall on the outstretched hand; its danger is to the brachial artery and nearby nerves.
How it's asked: The nerve most commonly injured (anterior interosseous), Volkmann's ischaemic contracture, and the commonest late deformity (cubitus varus).
Why this is true
In children the supracondylar region is thin and weak, so a fall on the outstretched hand hyperextends the elbow and the distal fragment is displaced backwards. The sharp proximal fragment is then driven forward into the antecubital fossa, where it can tear or kink the brachial artery and stretch the median nerve (especially its anterior interosseous branch). If arterial flow is compromised, the forearm flexor muscles become ischaemic, swell inside their fascia (compartment syndrome) and later fibrose — Volkmann's ischaemic contracture.
Key points
Common traps
- A pink, pulseless hand may still be perfused; a white, pulseless hand needs urgent exploration.
- The three-point relationship is maintained in supracondylar fracture but disturbed in elbow dislocation.
Clinical case
A 7-year-old fell on his outstretched hand. The elbow is swollen and he can't flex the tip of his thumb and index finger to make an 'O'. Radial pulse is present.
High-yield
Commonest nerve injured: anterior interosseous (median). Commonest late deformity: cubitus varus. Brachial artery injury → Volkmann's contracture.
Quick check
Q1.Commonest late complication of supracondylar fracture of the humerus:
Q2.Volkmann's ischaemic contracture most commonly affects: