Omid, J Bone Joint Surg Am 2008 - Supracondylar Humeral Fractures in Children - Article Summary

Supracondylar Humeral Fractures in Children.

Omid, Skaggs, et al.·J Bone Joint Surg Am·2008·555 citations·Pediatrics

This 2008 Current Concepts Review from Children's Hospital Los Angeles synthesizes evidence on supracondylar humeral fractures — the most common elbow fracture in children. It addresses the most contested clinical decisions: operative indications by fracture type, pin configuration, vascular management, and complication avoidance. The authors use the modified Gartland classification as the organizational framework throughout.

Key Findings

The modified Gartland classification defines four fracture types with distinct treatment implications:
- Type I: nondisplaced (<2 mm), intact anterior humeral line — long arm cast ~3 weeks
- Type II: displaced >2 mm, posterior cortex hinged. Operative fixation now preferred over cast
- Type III: no cortical contact, extensive periosteal tearing. Operative reduction and pinning is standard of care
- Type IV: circumferential periosteal disruption, multidirectional instability (~3% of displaced fractures). Requires special pinning protocol under anesthesia
Lateral-only pins carry 0.7% ulnar nerve injury risk vs 3.4% with crossed pins (systematic review, 35 articles, >1900 cases). Adding a medial pin with the elbow in hyperflexion spikes the risk to 15%. This is why lateral-only constructs are now the preferred technique at high-volume centers.
Medial comminution is a subtle radiographic finding that mandates pinning regardless of how minimally displaced the fracture appears. Cubitus varus developed in 4 of 7 patients treated nonoperatively vs 0 of 6 treated with operative fixation.
In pulseless limbs, urgent fracture reduction alone restored perfusion in 14 of 17 cases without angiography. Angiography delays treatment and did not alter management in any of 4 cases where it was used. Take the patient to the OR, not the angiography suite.
All 8 cases of lateral-pin fixation loss in one series were caused by identifiable technical errors:
- Failure to engage both fragments with two or more pins
- Failure to achieve bicortical fixation with two or more pins
- Inadequate pin separation (<2 mm) at the fracture site
- Fixation failure with lateral pins is a technique problem, not a construct problem.

Board PearlLateral-only pins eliminate iatrogenic ulnar nerve injury risk while providing equivalent stability — avoid medial pins, especially with the elbow hyperflexed.

Core

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Mesenchymal Stem Cells.

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Hoffman, Kunkel, et al.Cell19874,747 citations

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