From the Guidelines
Treatment of a supracondylar fracture in a 6-year-old typically involves closed reduction and percutaneous pinning, especially for displaced fractures (Gartland types II and III). The child should be taken to the operating room promptly, ideally within 24 hours of injury to minimize complications, as highlighted in the studies 1. Under general anesthesia, the orthopedic surgeon will manipulate the fracture into alignment and then stabilize it with Kirschner wires (K-wires) inserted through the skin. Following the procedure, the arm is immobilized in a posterior splint or long-arm cast with the elbow flexed at approximately 90 degrees for 3-4 weeks. For minimally displaced fractures (Gartland type I), cast immobilization alone may be sufficient, as noted in the study 1.
Close neurovascular monitoring is essential in the immediate post-injury period to watch for compartment syndrome or vascular compromise, a concern also raised by Andrew Howard, MD, et al 1. Physical therapy is often recommended after cast removal to restore range of motion. This treatment approach is preferred because children have excellent healing potential, and proper anatomic alignment is crucial to prevent long-term complications such as cubitus varus deformity ("gunstock deformity") or limitations in elbow function, as discussed in the guidelines 1.
Key considerations in the treatment include:
- Prompt surgical intervention for displaced fractures to minimize complications
- Use of closed reduction and percutaneous pinning for Gartland types II and III fractures
- Cast immobilization for minimally displaced fractures
- Close monitoring for neurovascular complications
- Physical therapy after cast removal to restore range of motion These approaches are supported by the evidence from the American Academy of Orthopaedic Surgeons 1, emphasizing the importance of evidence-based practice in the treatment of pediatric supracondylar humerus fractures.
From the Research
Treatment of Supracondylar Fractures
The treatment of supracondylar fractures in children typically involves closed reduction and percutaneous pinning, especially for type III injuries 2. This technique is preferred as it helps avoid complications such as vascular insufficiency and cubitus varus.
Closed Reduction and Percutaneous Pinning
Closed reduction with percutaneous pin fixation is often used for extension fractures, particularly those with complete displacement (type III patterns) 3. The use of percutaneous pinning following closed reduction is a common approach for managing these fractures, with the pins left protruding through the skin to be removed later 2.
Factors Associated with Successful Closed Reduction
Studies have identified factors associated with successful closed reduction and immobilization, including the use of procedural sedation during reduction 4. The success of closed reduction does not significantly differ based on sex, laterality, mechanism of injury, or type of fracture immobilization 4.
Management of Type II Supracondylar Fractures
For type II supracondylar fractures, closed reduction under sedation with immobilization may be an effective treatment approach 5. The use of equimolar nitrous oxide as conscious sedation for closed reduction and casting appears to be a safe and appropriate conservative method of treatment for displaced type II supracondylar fractures in children 5.
General Management Principles
In general, the management of supracondylar fractures involves monitoring vascular status, excluding concomitant upper-limb fractures, and considering the risk of compartment syndrome 6. Closed reduction and percutaneous pinning is the gold standard surgical treatment, with open reduction via the anterior approach indicated for specific cases such as open fractures or failed closed reduction 6.
- Key considerations in treatment include: