MDM - Supracondylar Fracture

[##]-year-old [male/female] with history and exam consistent with [right/left] supracondylar fracture.

Initial consideration in this patient included supracondylar and other fractures of the humerus, elbow fractures including olecranon and radial head fracture, forearm fractures, dislocations involving the elbow, soft tissue injuries, and non-accidental trauma (NAT) amongst others. 

Patient presented with [mother/father/parents] for pain and swelling to the [right/left] upper extremity following a [fall/describe injury].  Child noted to be refusing to move the affected arm.  A radial head subluxation (nursemaid’s elbow) was felt to be unlikely given mechanism and tenderness to palpation over the posterior aspect of the humerus of the [right/left] arm.  Plain films were obtained with evidence of [nondisplaced supracondylar fracture with evidence of elbow effusion (anterior sail sign and/posterior fat pad) consistent with type I fracture (Gartland Classification)/displaced supracondylar fracture with intact posterior periosteum and anterior displacement of the anterior humeral line relative to the capitellum consistent with type II fracture (Gartland Classification)/displaced supracondylar fracture with disruption of anterior and posterior periosteum consistent with type III (Gartland Classification)/displaced supracondylar fracture with complete periosteal disruption with instability in flexion and extension consistent with type IV (Gartland Classification)].  Patient noted to have [no] evidence of open fracture [with antibiotics initiated in the ED and case discussed with orthopedics].  Patient noted to have [no] evidence of associated radial nerve injury, [especially important to check for in distally displaced type III] median nerve, brachial artery injury [especially important to check in posterolaterally displaced type III] or other neurovascular injuries.

Patient was noted to have no other significant injuries on exam in the ED.  Doubt non-accidental trauma in patient with description of trauma from [mother/father/parents] consistent with noted injuries and absence of other concerning features on history and exam.

Patient placed in [double sugar tongue/long-arm posterior splint with elbow at 90°  and forearm in pronation/neutral position/long-arm cast by orthopedics] with neurovascular exam noted to be normal before and after immobilization [type II-IV fractures require orthopedics consult in the ED/type I can usually be discharged with 48-hour follow up].  We discussed appropriate [splint/cast] care prior to discharge home with the patient’s [mother/father/parents]. 

We discussed return precautions, specifically for evidence suggestive of compartment syndrome, symptomatic treatment [with analgesics/NSAIDs], and follow up with Orthopedics within 48-hours for further evaluation, and the patient’s [mother/father/parents] demonstrated understanding and agreement with this plan.

https://www.orthobullets.com/pediatrics/4007/supracondylar-fracture--pediatric
https://orthoinfo.aaos.org/en/diseases--conditions/elbow-fractures-in-children/