Supracondylar humeral fractures are the most common elbow fractures in children requiring operative intervention. They are classified according to the Gartland system as nondisplaced (type I), displaced with hinging and the posterior cortex intact (type II), and completely displaced (type III). The standard treatment for type-II and III fractures is closed reduction and percutaneous pinning. The timing of surgery depends on the severity of the fracture and the presence of any neurovascular injury. Preoperative assessment of the neurologic and vascular status is imperative, and can be challenging in a young child. The steps of the surgical procedure consist of the following.
The pins are removed between 3 and 4 weeks postoperatively, depending on patient age, and range of motion is initiated. Elbow stiffness is common for 4 to 6 weeks, but a return to a nearly full range of motion can be expected. Resumption of normal activities should be delayed until the fracture is fully healed and the range of motion is nearly normal.