UMEM Educational Pearls

Category: Pediatrics

Title: Never miss a supracondylar fracture!

Keywords: pediatrics, orthopedics, fracture (PubMed Search)

Posted: 6/6/2024 by Kathleen Stephanos, MD (Emailed: 6/10/2024) (Updated: 6/10/2024)
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The supracondylar fracture is one of the most common pediatric fractures. It typically occurs due to a FOOSH injury and is a result of fracture through an area of high growth (and therefore weaker bone structure) in the pediatric distal humerus. Appearance on x-ray depends on the degree of displacement, however in cases without obvious displacement, providers must look for more subtle signs on x-ray. For example, a “sail sign” of the anterior fat pad and appearance of a posterior fat pad indicate a joint effusion and are suggestive of a fracture. However, there are often still equivocal x-rays in children with notable tenderness on exam, and failure to appropriately immobilize these fractures can result in pain and higher risk of injury resulting in displacement. 

In 2021, Varga et al, looked into the ability to assess for supracondylar fractures with ultrasound. This prospective study evaluated 5 locations in the pediatric elbow for signs of fracture. Ultimately, this was able to identify more fractures than x-ray alone, and was a useful tool for equivocal cases. This is not an isolated study, but one of the most comprehensive, looking into ultrasound as a tool for supracondylar fracture identification.

It may be time to grab that ultrasound probe to look for fractures in pediatric patients with pain but an unclear elbow x-ray.


Varga M, Papp S, Kassai T, Bodzay T, Gáti N, Pintér S. Standardized sonographic examination of pediatric elbow injuries is an effective screening method and improves diagnostic efficiency. Injury. 2021 Mar;52 Suppl 1:S25-S30. doi: 10.1016/j.injury.2020.02.056. Epub 2020 Feb 28. PMID: 32173077.