What's the diagnosis? By Dr. Geno Marrone

A 76 yo female presents after a fall on an outstretched right arm.  She has right elbow pain, tenderness, and swelling.  An xray is shown.  What's the diagnosis?  Scroll down for answer.





Answer:  Supracondylar fracture of the distal humerus



  • Most commonaly, a fall on an outstretched arm


  • Type I: undisplaced
  • Type II: displaced with intact posterior cortex
    • Type IIa: no rotational deformity
    • Type IIb: rotational deformity
  • Type III: complete displacement


  • Clinical signs/symptoms
      • Pain on passive extension of elbow
      • Usually a forearm held in pronation
  • Imaging
      • Sail sign: anterior fat pad is elevated by a joint effusion, appears as a lucent triangle on the lateral projection
      • Posterior fat pad sign, a lucency in the olecranon fossa on the true lateral elbow xray with elbow flexed at 90 degrees
      • Anterior humeral line should intersect the middle third of the capitellum on the ture lateral xray.


      • Type I: stable, immobilization and prompt out patient orthopedic follow up
      • Type IIa: immobilization flexed at 120 degrees vs surgical pinning
      • Type IIb: reduction +/- fixation
      • Type III: Closed reduction and percutaneous pinning vs open reduction


      • Volkmann ischemic contracture: forearm compartment syndrome due to damage/occlusion of the brachial artery
      • damage to the ulnar, median or radial nerves
          • most commonly anterior interosseous nerve (branch of the median nerve) causing weakness of hand flexors (difficulty making the OK sign) and abduction of the thumb





Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.