The broken bone can damage the nerves that cross the elbow.

These nerves are important in hand movement and feeling.

The broken bone can damage the nerves that cross the elbow.

Sometimes, the broken bone can damage the main artery to the hand in the following ways:

There is a 5/1000 risk of needing to repair an injured artery.
Sometimes, the broken bone can also break open the skin which may cause a bone infection.

Sometimes, the broken bone can damage the main artery to the hand in the following ways:

Illustration type 3 fracture entrapping artery
Illustration type 3 fracture pushing on artery

There is a 5/1000 risk of needing to repair an injured artery.
Sometimes, the broken bone can also break open the skin which may cause a bone infection.



Why is surgery the best treatment choice?

A cast, without surgery, is an option but surgery gives your child the best chance to have their elbow and hand:

  1. Move like it did before the injury.
  2. Look like it did before the injury.
  3. Feel like it did before the injury.

Why is surgery the best treatment choice?

A cast, without surgery, is an option but surgery gives your child the best chance to have their elbow and hand:

  1. Move like it did before the injury.
  2. Look like it did before the injury.
  3. Feel like it did before the injury.

Possible Risks Without Surgery

arm and hand pointing down facing forward, with a pronounced angle between thumb and wrist

Cubitus Varus

arm and hand pointing down facing forward, with a much less pronounced angle between thumb and wrist

Normal

Risks Associated With Cast-Only Treatment:
Cubitus Varus

Without surgery, your child’s arm is less likely to look like their uninjured arm.

bent arm with fist pointing toward head at about a 60 degree angle

Impaired Range Of Motion

bent arm with fist pointing toward head at about a 40 degree angle

Normal Range Of Motion

Risks Associated With Cast-Only Treatment:
Impaired Range of Motion

Without surgery, your child’s elbow is less likely to move like their uninjured elbow

arm with hand in a claw-like position

Compartment Syndrome

Compartment syndrome occurs when the swelling and pressure inside the muscle stops new blood from reaching muscle and nerve cells. Without urgent surgery, it can lead to permanent muscle and nerve damage that can result in a hand that doesn’t work properly (Volkmann’s Ischaemic Contracture as seen above).

arm with a curved line on the forearm indicating incision arm with a curved line spanning all of the forearm indicating incision

Fasciotomy

If your child developed compartment syndrome, your child’s doctor would release the pressure inside the muscle by making a long cut along the arm. This is called a fasciotomy. After a fasciotomy, your child may need another surgery to stitch up the cut once the swelling has gone down. Sometimes, the swelling is so severe, a skin graft is used to cover up the cut.
There is a much smaller risk (less than 1/1000) of your child developing compartment syndrome and needing a fasciotomy if your child’s fracture is treated with surgery rather than with a cast.

What does surgery involve?

bone illustration showing a type 3 humerus fracture bone illustration showing a repaired type 3 humerus fracture

During surgery, your child’s doctor will realign the broken bone.

bone illustration showing pins placed near humerus fracture

The doctor will then hold the broken bone in place with temporary pins. These temporary pins are placed through the skin and are taken out about 3 weeks later. They usually leave very small round scars that are barely noticeable. There is a 120/1000 chance that your child might need a small cut (less than 2 cm) in the skin during surgery to safely place the temporary pins. There is a 20/1000 chance that your child might need a larger cut (usually about 5cm) in the skin during surgery to realign the bones. Your child’s doctor will let you know if they think this will be necessary.

illustation showing arm in a cast

Before your child wakes up, the doctor will finish by placing the arm in a backslab (half cast) and sling.

What are the risks of surgery?

There is a very small chance of the following:

Overall, your child has a very small chance of needing a second operation (25/1000) for either an infection, loss of position of fracture, nerve injury, artery injury or compartment release.

What are the risks of surgery?

Overall, your child has a very small chance of needing a second operation (25/1000) for either an infection, loss of position of fracture, nerve injury, artery injury or compartment release.

What are the chances of my child making a complete recovery?

The vast majority of children have an excellent outcome following surgery

What are the chances of my child making a complete recovery?

Typical Patient Journey
Emergency Department

Your child will have already been seen by the Emergency Department doctor and x-rays of your child’s elbow have been taken. If it hasn’t been put on already, a backslab (half cast) will splint your child’s elbow which will help control their pain.

Depending on the severity of your child’s injury, a member of your child’s surgical team will come to assess your child in the Emergency Department or on the Ward. Your child’s doctor or nurse will let you know if and when your child will be allowed to eat or drink.

What happens next?

Typical Patient Journey

1. Emergency Department

Your child will have already been seen by the Emergency Department doctor and x-rays of your child’s elbow have been taken. If it hasn’t been put on already, a backslab (half cast) will splint your child’s elbow which will help control their pain.

Depending on the severity of your child’s injury, a member of your child’s surgical team will come to assess your child in the Emergency Department or on the Ward. Your child’s doctor or nurse will let you know if and when your child will be allowed to eat or drink.

Illustration of ambulance with its light flashing

2. Ward Pre-Operation

On the ward, a nurse will be checking in on your child every 2 to 4 hours to ensure that the nerves and arteries to the hand are working well. Importantly, the nurse will check for signs of compartment syndrome—a build-up of pressure in the arm which can lead to muscle and nerve damage. Your child’s doctor or nurse will let you know if and when your child will be allowed to eat or drink.

The typical child with a supracondylar fracture will be discharged within 12 hours following surgery. However, 10% of patients have to wait more than 24 hours for surgery

Illustration of a hospital with sun and moon above it

3. Operating Room

Your child will be transported to the operating room where an anaesthetist will safely put them to sleep.

Illustration of doctor wearing a mask and head lamp

4. Recovery Room

Once your child has settled in the recovery room, you will be able to be with them while they wake up.

Illustration of hospital bed with z's above it

Ward Post-Operation

On the ward, a nurse will be checking in on your child every 2 to 4 hours to ensure that the nerves and arteries to the hand are working well. Importantly, the nurse will check for signs of compartment syndrome—a build-up of pressure in the arm which can lead to muscle and nerve damage. The typical child with a supracondylar fracture will be discharged within 12 hours following surgery. Your surgeon may request that your child is kept for a longer observation period.

Illustration of a clipboard, badge, bandaid and pill bottle

Home

Your child’s nurse will provide you with details on how to care for your child at home.

Illustration of the front of a house

Follow up

Your child will have a review by the surgeon in the fracture clinic or outpatient clinic about 3 weeks after the surgery. At this appointment, the backslab will be taken off, the pins will be removed, and x-rays of the elbow will be taken.

Another appointment will be arranged for 3 months following the date of injury to check the movement of the elbow. Most children will be discharged from the clinic at this stage.

MoreLess Information About Removing Pins
  • A toy, book, smartphone or tablet may distract your child and make them feel less worried.
  • The feeling of the pins being removed is similar to a pinch. The pain settles quickly so pain medication is not helpful.
  • It is normal for there to be a small amount of bleeding when the pins are removed but this too stops quickly after a small bandage is applied
Illustration of a stethoscope

Ward Pre-Operation

On the ward, a nurse will be checking in on your child every 2 to 4 hours to ensure that the nerves and arteries to the hand are working well. Importantly, the nurse will check for signs of compartment syndrome—a build-up of pressure in the arm which can lead to muscle and nerve damage. Your child’s doctor or nurse will let you know if and when your child will be allowed to eat or drink.

The typical child with a supracondylar fracture will be discharged within 12 hours following surgery. However, 10% of patients have to wait more than 24 hours for surgery

What happens next?

Operating Room

Your child will be transported to the operating room where an anaesthetist will safely put them to sleep.

What happens next?

Recovery Room

Once your child has settled in the recovery room, you will be able to be with them while they wake up.

What happens next?

Ward Post-Operation

On the ward, a nurse will be checking in on your child every 2 to 4 hours to ensure that the nerves and arteries to the hand are working well. Importantly, the nurse will check for signs of compartment syndrome—a build-up of pressure in the arm which can lead to muscle and nerve damage. The typical child with a supracondylar fracture will be discharged within 12 hours following surgery. Your surgeon may request that your child is kept for a longer observation period.

What happens next?

Home

Your child’s nurse will provide you with details on how to care for your child at home.

What happens next?

Follow up

Your child will have a review by the surgeon in the fracture clinic or outpatient clinic about 3 weeks after the surgery. At this appointment, the backslab will be taken off, the pins will be removed, and x-rays of the elbow will be taken.

Another appointment will be arranged for 3 months following the date of injury to check the movement of the elbow. Most children will be discharged from the clinic at this stage.

MoreLess Information About Removing Pins
  • A toy, book, smartphone or tablet may distract your child and make them feel less worried.
  • The feeling of the pins being removed is similar to a pinch. The pain settles quickly so pain medication is not helpful.
  • It is normal for there to be a small amount of bleeding when the pins are removed but this too stops quickly after a small bandage is applied

Signs of a problem:

Signs of a problem

hand burning (red) with pain
illustration of almost completely white hand
hand with fingers disappearing
illustration of curled hand
hand tingling


Let’s recap

bone illustration showing type 3 humerus fracture

Your child needs surgery to realign their broken arm.

bone illustration showing pins placed near humerus fracture

During surgery, temporary pins and a backslab (half cast) are used to hold the broken bone in place while it heals.

illustration showing arm in a cast

The backslab and pins will be removed in the clinic about 3 weeks after surgery

illustration of soccer ball, basketball and football

Your child will need to avoid high-risk activities for a total of 12 weeks after their injury.

illustration of a calendar

Your child’s elbow may need a year to fully recover strength and movement.

Thank you

Thank you for taking the time to complete this module. Your child’s doctor will go over this information again and answer any questions you may have shortly.