A child will complain of pain and swelling over the elbow immediately post trauma with loss of function of affected upper limb.

Late onset of pain (hours after injury) could be due to muscle ischaemia (reduced oxygen supply).

Clinical parameters such as temperature of the limb extremities (warm or cold), capillary refilling time, oxygen saturation of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of peripheral nerves (radial, median, and ulnar nerves), and any wounds which would indicate open fracture.

Doppler ultrasonography should be performed to ascertain blood flow of the affected limb if the distal pulses are not palpable.

Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus.

[3] Swelling and vascular injury following the fracture can lead to the development of the compartment syndrome which leads to long-term complication of Volkmann's contracture (fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpophalangeal joint ).

[citation needed] Extension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow.

[4] A supracondylar humerus facture is diagnosed by x-ray and the injured limb will be examined to assess the surrounding soft tissue, neurovascular status, and to identify any other injuries to the affected area.

For fractures with significant displacement, the bone end can be trapped within the biceps muscle with resulting tension producing an indentation to the skin, which is called a "pucker sign".

[citation needed] The vascular status must be assessed, including the warmth and perfusion of the hand, the time for capillary refill, and the presence of a palpable radial pulse.

Limb vascular status is categorized as "normal," "pulseless with a (warm, pink) perfused hand," or "pulseless–pale (nonperfused)" (see "neurovascular complications" below).

The neurologic status must be assessed including the sensory and motor function of the radial, ulnar, and median nerves (see "neurovascular complications" below).

Ideally, splintage should be used to immobilise the elbow at 20 to 30 degrees flexion in order to prevent further injury of the blood vessels and nerves while doing X-rays.

Bleeding from the fracture expands the joint capsule and is visualized on the lateral view as a darker area anteriorly and posteriorly, and is known as the sail sign.

In case the varus of the fracture site is more than 10 degrees when compared to the normal elbow, closed reduction and percutaneous pinning using X-ray image intensifier inside operating theater is recommended.

Closed reduction can be done by applying traction along the long axis of the humerus with elbow in slight flexion.

Therefore, closed or open reduction together with percutaneous pinning within 24 hours is the preferred method of management with low complication rates.

Straight arm lateral traction can be a safe method to deal with Gartland Type III fractures.

[3] Percutaneous pinning are usually inserted over the medial or lateral sides of the elbow under X-ray image intensifier guidance.

[3] Percutaneous pinning should be done when close manipulation fails to achieve the reduction, unstable fracture after closed reduction, neurological deficits occurs during or after the manipulation of fracture, and surgical exploration is required to determine the integrity of the blood vessels and nerves.

All Type II and III fractures requiring elbow flexion of more than 90° to maintain the reduction needs to be fixed by percutaneous pinning.

[3] In patients with a "pink but pulseless hand" (absent radial pulse but demonstrable perfusion at extremities) after successful reduction and percutaneous pinning, there is uncertainty about the ideal management and imaging or surgical exploration should be considered[11] given the risk of Volkmann's contracture.