The management of severely displaced supracondylar fractures of the humerus

The separation of supracondylar fractures into three types facilitates their treatment. Type I fractures are undisplaced and need no manipulation prior to immobilization. Type II fractures have an intact posterior cortex and can be managed with simple flexion of the elbow prior to immobilization with a cast. In the type II fractures, the complete displacement of the fragments requires a more extensive manipulation to achieve a reduction. Percutaneous pin fixation is usually needed to maintain the reduction. The posterolateral or posteromedial position of the distal fragment has a bearing on the type of nerve or vascular structure most likely to be injured, which pin to place first in securing the reduction, and the proper surgical approach to use if an open reduction is necessary. If an adequate reduction cannot be achieved by closed methods, open reduction provides a better alternative to traction. The success of treatment requires first achieving an adequate reduction and then maintaining the reduction throughout the healing period. Surgery alone does not ensure a good result.