This 1997 review by Otsuka and Kasser covers the classification, radiographic evaluation, treatment algorithm, and complication management of supracondylar humerus fractures in children. It addresses the full spectrum from nondisplaced Type I injuries through completely displaced Type III fractures with neurovascular compromise. The central question is how to achieve anatomic reduction, stabilize the fracture, and manage the pulseless or nerve-injured limb.
Supracondylar humerus fracture is the most common elbow injury requiring hospitalization in children, and historically it carried high rates of malunion and neurovascular complications when managed with casting in hyperflexion or skeletal traction alone.
When you see a Type III supracondylar fracture, the management is closed reduction and percutaneous pinning — not casting. The direction of displacement tells you where to look first: posterolateral displacement means examine the brachial artery, posteromedial means test median nerve function carefully.
When the hand is pulseless after fracture, do not wait for arteriography. Reduce and pin immediately. Pulse returns in the majority of patients because the vessel is kinked, not transected. If pulse remains absent after reduction, then explore.
For pinning technique, placing the medial pin through a small incision with blunt dissection to the epicondyle protects the ulnar nerve and is the key step that prevents the 2%–3% iatrogenic nerve injury rate associated with percutaneous medial pin placement.
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This 1997 review by Otsuka and Kasser covers the classification, radiographic evaluation, treatment algorithm, and complication management of supracondylar humerus fractures in children. It addresses the full spectrum from nondisplaced Type I injuries through completely displaced Type III fractures with neurovascular compromise. The central question is how to achieve anatomic reduction, stabilize the fracture, and manage the pulseless or nerve-injured limb.
Supracondylar humerus fracture is the most common elbow injury requiring hospitalization in children, and historically it carried high rates of malunion and neurovascular complications when managed with casting in hyperflexion or skeletal traction alone.
When you see a Type III supracondylar fracture, the management is closed reduction and percutaneous pinning — not casting. The direction of displacement tells you where to look first: posterolateral displacement means examine the brachial artery, posteromedial means test median nerve function carefully.
When the hand is pulseless after fracture, do not wait for arteriography. Reduce and pin immediately. Pulse returns in the majority of patients because the vessel is kinked, not transected. If pulse remains absent after reduction, then explore.
For pinning technique, placing the medial pin through a small incision with blunt dissection to the epicondyle protects the ulnar nerve and is the key step that prevents the 2%–3% iatrogenic nerve injury rate associated with percutaneous medial pin placement.