Prior to surgical planning for a displaced supracondylar humerus fracture, one must ensure an adequate physical exam has been performed: Because of the potential neurovascular compromise or compartment syndrome seen with this fracture pattern, an expeditious physical exam by an orthopaedic surgeon is necessary to aid in the treatment plan. If treated with immobilization, nondisplaced or minimally displaced supracondylar humerus fracture should be monitored with repeat radiographs after 1 week. As a rule, minimally displaced extension-type supracondylar humerus fractures in which the capitellum is posterior to a line drawn from the anterior humeral line indicates unacceptable extension and therefore should be undergo a CRPP (Figure 2). 6,8 CRPP fixation of type IB fractures was also recommended if varus malunion seems possible. Although the initial recommendation was weak based on quality of the available literature, pin fixation with displaced fractures were superior in preventing cubitus varus and loss of motion.Īlthough the AAOS Guidelines did not address Type IB injuries, these injuries might have a tendency to collapse into varus due to the comminution of the medial column. 8 A moderate recommendation for CRPP fixation was given to any displaced fracture (Gartland Type II and Type III). The American Academy of Orthopaedic Surgeons (AAOS) has recently published Guidelines on the treatment of Pediatric Supracondylar Humerus Fractures. The rationale for closed reduction and percutaneous pinning is that the distal fragment can be controlled by the pin fixation to decrease the incidence of varus malunion, while the arm can be positioned in a comfortable semi-extended position at the elbow, avoiding discomfort and complications associated with flexing an elbow against a swollen antecubital fossa. Minimally displaced fragments with medial column comminution or any malalignment in the coronal plane. ![]()
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