Supracondylar Fractures of the Humerus

Supracondylar humeral fractures are the most prevalent type of elbow fractures seen in children. Techniques for treating them have decreased complications in recent years. Several controversies remain regarding their treatment, such as operative treatment timing, pin fixation configuration, optimal treatment of type II supracondylar fractures, and management of neurovascular injuries. Current evidence is generally limited to retrospective studies and small patient numbers. Multicenter prospective trials are needed to define the best treatment for these fractures. Correct diagnosis and proper management are mandatory for avoiding neurovascular complications and malunion. Management decisions are based on a number of considerations particularly fracture stability. For management of these injuries, Gartland classification plays a fundamental role in decision-making. Literature recommends conservative management for fractures with non- or minimal displacement, while treatment for type II and III Gartland fractures is closed reduction and pin fixation. If pin placement configuration is adequate, lateral entry pins alone provide enough stability, avoiding the risk of iatrogenic ulnar nerve injury. In a pulseless limb, urgent reduction should be performed, an angiogram is not routinely indicated as it tends to delay surgical treatment and fracture reduction usually restores distal perfusion. Immediate nerve exploration in patients with a closed fracture is generally not indicated, as associated nerve injuries usually resolve with conservative management.