- Discussion:
- if the frx needs a reduction, then the frx is not a type I but a type II;
- posterior cortex remains intact, making it a greenstick frx;
- technically a type II frx implies posterior displacement, but frequently there will also be medial impaction w/ varus angulation, and hence there will be an need for
reduction and
percutaneous pinning in order to avoid
cubitus varus;
- Radiographs:
- consider the need for contralateral elbow radiographs to help determine normal anatomy;
- Treatment:
- these frx require adequate
reduction for acceptable alignment;
- requires use of GEA;
- involves correction of angulation in the frontal and saggital planes;
- reduction involves elbow pronation and flexion;
- arm is immobilized in pronation and an appropriate amount of flexion which should not exceed 120 deg;
-
percutaneous pinning is being used more liberally than in the past;
- chief indication for pinning is fracture which requires excessive elbow flexion for maintenance of reduction;
- relative indication is excessive arm swelling which may interfere w/ maintenance of reduction;
- because type II frx have an intact posterior cortex (w/ enhanced stability) consider use of 2 lateral pins (as opposed to medial and lateral pins);
- w/ 2 lateral pins, there is no risk to the ulnar nerve;
- pins may be parallel or crossed proximal to the frx site
Predictors of Failure of Nonoperative Treatment for Type-2 Supracondylar Humerus Fractures
Extension Type II Pediatric Supracondylar Humerus Fractures: A Radiographic Outcomes Study of Closed Reduction and Cast Immobilization
Factors predictive of early radiographic failure following closed reduction of Gartland Type II supracondylar humeral fractures
Type II Supracondylar Humerus Fractures: Can Some Be Treated Nonoperatively?
Natural History of Unreduced Gartland Type-II Supracondylar Fractures of the Humerus in Children: A 2-13 Year Follow-up Study
