Emergency Department Clinical Pathway for Supracondylar Humerus Fractures

  • Assess neurovascular status, pain
  • Ibuprofen, ice
  • RN Standing Order, 2 view elbow

History and Physical Exam
Assess for other injuries
Skin integrity, neurovascular exam


Supracondylar Fracture Classification
Image review by Radiology and Orthopedics to determine fracture classification

Type I Fracture
Type II Fracture
Type III Fracture
  • Long arm cast by ED tech
  • Orthopedics if no ED tech available
  • Ortho APP/resident discuss with Ortho attending ASAP to determine if child is eligible for outpatient OR
  • Cast or splint by Orthopedics
  • If casting, no more than 70° flexion
  • Splint in 30°-50° flexion by Orthopedics
  • Monitor pulses, neurovascular exam
Admit for surgical intervention
Follow-up in 1 week
  • Child to return within 72 hours for surgery (likely following day add-on)
  • Child NPO except clear liquids after midnight until contacted following morning (by noon) with time of surgery
  • KOPH Fracture Discharge Scheduling
Posted: December 2022
Revised: August 2023
Editors: Clinical Pathways Team