Supracondylar fractures are the most common upper extremity fracture in the pediatric population therfore every emergency medicine provider should be deeply familiar with the known complications of such pathology. This post will introduce the types of supracondylar fractures and known complications.

Gartland Classification of Supracondylar Fractures:

• Type I
• Type II
• Type III

Vascular Injury: 

• Vascular injury to the brachial artery occurs in up to 17% of suprcondylar fractures
• This occurs commonly in Type II and Type III supracondylar fractures

Volkmann Ischemic Contracture:

• Acute injury can lead to compartment syndrome in the first 12-24 hours
• If the compartment syndrome is not identified and treated an ischemic contracture can result
• Resulting contracture can lead to fixed flexion of the elbow, pronation of forearm, flexion of wrist, joint extension at MCP

Gunstock Deformity (cubitus varus deformity):

• Late complication of supracondylar fractures resulting in angular deformity of the distal humerus
• This complication typically does not affect function.
• Can rarely cause an ulnar nerve palsy
• Incidence of this has reduced with modern surgical techniques.

Fishtail Deformity:

• Avascular necrosis of the lateral trochlear ridge in the shape of a fishtail can result in late-onset chronic pain, synovitis, osteophytes, radial head subluxation

References:
1. Ryan, L et al. "Evaluation and management of supracondylar fractures in children." UpToDate, Inc. November 2016.
2. Image Credit: Dr. Abijhit Datir et al. "Supracondylar fracture." Radiopedia.org. 2017
3. Sheth et al. "Supracondylar Fracture- Pediatric." OrthoBullets: Elbow Fractures. 2017.