Supracondylar Fractures
The procedure for the management of paediatric supracondylar fractures includes:
Analgesia
Initial assessment should include provision of analgesia and a search for associated neurovascular complications.
Intranasal administration of analgesia (diamorphine) is a useful option in children and can delay attempts at intravenous access until topical anaesthesia has taken effect.
Treatment
Undisplaced fractures may be treated with a collar and cuff and can be followed up in fracture clinic. If there is significant pain, a back slab may be a better option.
Displaced fractures should all be referred for manipulation, urgently if circulation is compromised.
Complications
Complications include:
- Cubitus varus (gun stock deformity)
- Malunion and stiffness
- Myositis ossificans
- Nerve injury (most commonly the median nerve)
- Brachial artery (due to stretch and posterior displacement)
- Volkmanns ischaemic contracture (due to compartment swelling)