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Prospective Longitudinal Evaluation of Elbow Motion Following Pediatric Supracondylar Humeral Fractures
Hillard T. Spencer, MD1; Melissa Wong, BS2; Yi-Jen Fong, BA2; Adam Penman, BS2; Mauricio Silva, MD2
1 UCLA Orthopaedic Hospital Department of Orthopaedics, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 16-155 CHS, Los Angeles, CA 90095
2 Los Angeles Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for M. Silva: msilva@laoh.ucla.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Los Angeles Orthopaedic Hospital, Los Angeles, California

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):904-910. doi: 10.2106/JBJS.I.00736
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Temporary elbow stiffness after the treatment of a supracondylar humeral fracture in a child is often a concern of parents. However, little attention has been devoted to documenting, longitudinally, the time required for motion recovery. The purpose of the present study was to provide a prospective, longitudinal evaluation of elbow motion in a large population of pediatric patients undergoing treatment of a supracondylar humeral fracture.


We prospectively examined 373 patients (375 fractures) who presented to our urgent care center between March 1, 2007, and September 30, 2008. On the basis of a standard protocol, patients were managed with either casting or surgery, depending on the severity of the injury, and then were followed for a minimum of seven weeks. Values of elbow flexion and extension were recorded, and the relative arc of motion was calculated as a percentage of the motion of the contralateral elbow.


In general, following a supracondylar humeral fracture, the greatest increases in flexion, extension, and the absolute and relative arcs of motion are observed within the first month after cast removal, with a progressive improvement for up to forty-eight weeks after the injury. Age had a significant effect on the recovery of elbow motion, with patients older than five years of age demonstrating a 3% to 9% lower relative arc of motion at the follow-up points in comparison with younger patients. Similarly, patients with more-severe fractures requiring surgical treatment demonstrated a decrease in relative elbow motion of 10% (with respect to the contralateral side) at the time of cast removal in comparison with those who were managed nonoperatively.


The present study demonstrates that an initial rapid recovery in elbow motion can be expected after a supracondylar humeral fracture in a child, followed by a progressive improvement for up to one year after the injury. This motion recovery is slower in older patients and in those with more severe injuries.

Level of Evidence: 

Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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