Overview of the contemporary management of supracondylar humeral fractures in children

Abstract

Purpose: Supracondylar fractures are common injuries accounting for approximately 15% of all fractures in children with a large body of literature on this subject.

Methods: This article critically appraises the available evidence to provide an overview of the treatment options including the role and timing of surgery, the geometry of wire fixation and the management of nerve and arterial injury.

Conclusion: Management decisions are based on a number of considerations particularly fracture stability. Closed reduction and percutaneous K-wire stabilisation are commonly recommended for an unstable displaced fracture. These techniques are however associated with the potential for iatrogenic neurological injury. Vascular injury is also rare but must be recognised and treated promptly to avoid significant permanent morbidity.

Keywords: Cubitus Varus; Neurovascular; Review; Supracondylar; Treatment.

Fig. 1

The modified Gartland classification system a type I non-displaced, b type II moderately displaced, posterior cortex remains in continuity (IIa no rotation, IIb rotation), c type III complete displacement and d type IV unstable in flexion/extension (intraoperative discovery)

Fig. 2

Anterior humeral line (AHL, yellow dotted line) passing in front of the capitellum suggesting posterior/extension displacement of the distal humerus

Fig. 3

Flexion type supracondylar fracture

Fig. 4

Crossed wires used to stabilise a high medial (reverse oblique) fracture pattern

Fig. 5

Gartland III (AO 4) injury with posteromedial displacement

Fig. 6

Exploration of the brachial artery and median nerve for neurovascular injury

Fig. 7

Management flowchart for supracondylar fractures related to adequate and inadequate perfusion