The operative management of supracondylar fractures

Supracondylar fractures of the humerus occur in either an extension or flexion pattern. Both patterns have three types distinguished by the degree of displacement. Extension fractures, type III patterns in which there is complete displacement, usually require operative intervention in the form of a closed reduction with percutaneous pin fixation. In those in which an adequate reduction is not achieved, an open reduction is the preferred alternative treatment. Recognition of the role of the anterior periosteum in interfering with an adequate reduction is important. In addition, determination of the posteromedial or posterolateral displacement of the distal fragment is important in recognizing which neurovascular structures are more likely to be injured, which pin to place first, and which surgical approach is proper for an open reduction. Flexion fractures, type II distplaced fractures, often require pin fixation, and type III displaced fractures usually require an open reduction.