This 2012 JAAOS review by Abzug and Herman synthesizes contemporary evidence on pediatric supracondylar humerus fracture management, addressing classification, surgical timing, pin configuration, vascular injury, cubitus varus, and compartment syndrome — updating what was known from the foundational 1997 Otsuka and Kasser review.
When you see a displaced pediatric supracondylar fracture with an absent radial pulse but a pink, warm, well-perfused hand, do not reflexively explore the vessel — reduce and pin first, then observe 15–20 minutes; if perfusion is restored, splint in 40–60° flexion and admit for monitoring, but have a low threshold to explore given emerging data that 40/45 explored vessels in this scenario had true vascular injury requiring repair.
When pinning type III fractures, use at least three divergent lateral pins engaging both columns with bicortical purchase and >2 mm separation at the fracture site — these technical criteria, not the choice of lateral vs. Crossed, determine whether fixation holds.
This 2012 JAAOS review by Abzug and Herman synthesizes contemporary evidence on pediatric supracondylar humerus fracture management, addressing classification, surgical timing, pin configuration, vascular injury, cubitus varus, and compartment syndrome — updating what was known from the foundational 1997 Otsuka and Kasser review.
When you see a displaced pediatric supracondylar fracture with an absent radial pulse but a pink, warm, well-perfused hand, do not reflexively explore the vessel — reduce and pin first, then observe 15–20 minutes; if perfusion is restored, splint in 40–60° flexion and admit for monitoring, but have a low threshold to explore given emerging data that 40/45 explored vessels in this scenario had true vascular injury requiring repair.
When pinning type III fractures, use at least three divergent lateral pins engaging both columns with bicortical purchase and >2 mm separation at the fracture site — these technical criteria, not the choice of lateral vs. Crossed, determine whether fixation holds.