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Treatment of a supracondylar fracture

Three Part Question

in a [child aged 3-12] with a [spracondylar fracture of the humerus] is a [better outcome achieved with surgical intervention or immobilisation]

Clinical Scenario

An eight year old child presents with pain, swelling and local tenderness of the elbow, having fallen onto an outretched hand. a supracondylar fracture of the humerus is suspected. should this patient be treated with immobilisation or referred for surgery

Search Strategy

Medline 1966-June 20005
CINAHL 1982-June 2005
The Cochrane library, isuue 2 2005

Search Outcome

98 citations of which 2 high quality retrospective studies were found

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Palmer EE
July 1978
78 children (children's hospital)retrospective clinical trialvolkmann's contractureno instances following either mode of treatmentThe study was promoting screws of their own deign, so possibly could be bias in interpreting results. Some patients discontinued follow up. Treatments not randomly allocated, varied depending on the state of the fracture (e.g. displaced or not; absent radial pulse or not) making comparisons between treatments difficult
best mode of treatmentsurgery associated with better oucome than immobilisation
best mode of surgeryoverhead traction associated with best outcome
complications following surgeryrapid reolution of any neurovascular comprimise secondary to surgery
Weiland AJ
July 1978
USA and Switzerland
52 chidren, aged 2-13 years oldretrospective reviewcomplications following treatmentno cases of infection, non-union, anaesthetic complications, or evidence of myositis ossificansstatistical methods used are not described
pre-operative neurovascular complicationsall children had complete recovery within 14 days after surgery
complications of surgeryno patient suffered neural or vascular injury secondary to surgery
Angulation13/52 patients had less valgus angulation compared to uninjured elbow following surgery. 1/52 patients developeed cubital varus deformity


treatment of a supracondylar fracture of the humerus is a difficult task as this type of fracture is associated with many complications.

Clinical Bottom Line

surgical intervention leads to improved outcome in a supracondylar fracture of the humerus


  1. Palmer EE Supracondylar fracture of the humerus in children
  2. Weiland AJ Surgical treatment of displaced supracondylar fractures of the humerus in children