Supracondylar fractures: what's new?

In the past 5 to 7 years many advances have been made in the treatment of type III supracondylar fractures of the humerus. Gartland's three-type classification has continued to be used as a valuable tool to determine the aggressiveness of treatment. Use of cast immobilization for type III injuries has been shown to produce inferior results. Percutaneous pin fixation for reduced fractures has been established as the ideal treatment for most type III displaced fractures. Mediolateral or three lateral pin constructs provide the most rigid fixation. It is now apparent that the anterior interosseous nerve is probably the most commonly injured nerve. Recent technology in evaluating the vascular system has shown that the incidence of injuries to the brachial artery is probably higher than originally suspected. However, the management of these arterial injuries in patients who appear to have adequate profusion of the forearm musculature for normal function is still controversial, with recommendations varying from simple observation to aggressive primary arterial repair. Cubitus varus has been found to be due primarily to angulation in the coronal plane. Fortunately the incidence of complications after corrective osteotomies with this deformity has decreased from 50% to less than 15%. Although ipsilateral fractures are usually the result of greater forces of trauma, the incidence of associated neurovascular compromise does not appear to be any greater. Better recognition of flexion-type injuries has shown that the incidence is greater than originally suspected. A large percentage of these completely displaced flexion injuries may require open surgical intervention to obtain adequate reduction.