This patient had penetration of the spike of the proximal fragment into the subcutaneous tissue. In the anteroposterior view (Panel A), there is a large puckering or defect in the skin where the distal fragment has pulled the skin inward. Laterally (Panel B), there is puckering of the skin (arrow) in the area where the spike has penetrated into the subcutaneous tissue.
Reproduced with permission from: Kasser JR, Beaty JH. Supracondylar fractures of the distal humerus. In: Rockwood and Wilkins' Fractures in Children, 5th ed, Beaty JH, Kasser JR (Eds), Lippincott Williams & Wilkins 2001. Copyright © 2001 Lippincott Williams & Wilkins.
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