Pediatric supracondylar humerus fracture.

Most pediatric supracondylar humerus fractures are treated in an operative fashion if there is displacement or angulation. Most of those are extension type fractures and contrary to older beliefs medial pins are not critical for rotational stability of the fracture. There are studies today that demonstrate that larger pins, or two or three lateral pins are biomechanically equally effective compared to combined lateral and medial pinning. Medial pinning should be avoided due to risks of iatrogenic injury to the ulnar nerve. If need to be placed then I would recommend making a small medial elbow incision to visualize the ulnar nerve and the insert the medial pin safely.

Further reading: http://www.ncbi.nlm.nih.gov/pubmed/22706457
http://www.ncbi.nlm.nih.gov/pubmed/22327455

In the following case a Gartland extension type II supracondylar humerus fracture is illustrated. The patient was a 4 year old male that fell of the monkey bars. Was neurovascurarly intact at the time of evaluation. A few technical tips for fixation of these fractures are (1) use a hand table and avoid rotation of the elbow or arm when trying to obtain lateral XRs. Rotation of the arm that may lead to loss of reduction (2) aspirate the hematoma at the olecranon tip prior to reduction  - that facilitates easier reduction (3) Advance the lateral pin just proximal to the fracture line and use it as a joystick to manipulate the distal fragment

Patient regained all ROM after fixation and had no complication