From the Guidelines
The treatment for a supracondylar fracture of the humerus should prioritize closed reduction with pin fixation for displaced fractures, as recommended by the American Academy of Orthopaedic Surgeons (AAOS) guideline 1. This approach is supported by the AAOS guideline, which suggests closed reduction with pin fixation for patients with displaced pediatric supracondylar fractures of the humerus, with a moderate strength of recommendation 1.
Key Considerations
- Non-displaced or minimally displaced fractures (Type I) can be managed conservatively with immobilization in a long arm cast with the elbow flexed at 60-90 degrees for 3-4 weeks.
- Displaced fractures (Types II and III) typically require surgical intervention with closed reduction and percutaneous pinning (CRPP) under general anesthesia.
- Careful neurovascular monitoring is essential due to the risk of compartment syndrome and nerve injuries, particularly to the median, radial, and ulnar nerves.
- Pain management typically includes acetaminophen and/or ibuprofen for mild to moderate pain, with short-term opioids sometimes needed initially after surgery.
Surgical Intervention
The AAOS guideline recommends emergent closed reduction of displaced pediatric supracondylar humerus fractures in patients with decreased perfusion of the hand, with a weak strength of recommendation 1. In cases where closed reduction is not possible, open reduction may be necessary, as supported by the AAOS guideline, which recognizes that a percentage of pediatric supracondylar fractures of the humerus cannot be reduced using a closed technique 1.
Management of Vascular Injury
The management of pediatric supracondylar humerus fractures with vascular injury should be based on the patient's vascular status, perfusion, and other factors, as outlined in the AAOS Appropriate Use Criteria (AUC) document 1. The AUC document provides guidance on the management of pediatric supracondylar humerus fractures with vascular injury, including the use of closed reduction and pinning, and the consideration of vascular status and perfusion in treatment decisions.
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From the Research
Treatment Options for Supracondylar Fracture of Humerus
The treatment for a supracondylar fracture of the humerus typically involves:
- Closed reduction and percutaneous pinning for most displaced injuries (types II, III, and IV) 2
- Nonsurgical management for type I fractures 2
- Surgical intervention for displaced flexion-type supracondylar humerus fractures 3
Post-Operative Management
Post-operative management may involve:
- Casting or splinting to immobilize the fracture 4
- The choice between casting and splinting may depend on the age of the patient and the specific fracture characteristics 4
- Both casting and splinting are effective immobilization methods with few complications 4
Surgical Considerations
Surgical considerations include:
- The use of lateral pins only may be sufficient for stabilizing most fractures, reducing the risk of ulnar nerve injury 5
- The configuration of pins does not affect the maintenance of reduction of either Gartland type-2 or type-3 fractures 5
- In situ splinting prior to closed reduction and pinning in the operating room may reduce anesthesia exposure without increasing postoperative complications or suboptimal outcomes 6
Fracture Types and Treatment
Different types of supracondylar fractures may require different treatment approaches:
- Extension-type supracondylar fractures: closed reduction and percutaneous pinning is the mainstay of treatment 2
- Flexion-type supracondylar fractures: may require open reduction and stabilization due to their relatively high rate of requirement for open reduction and potential for ulnar nerve injury or entrapment 3