The treatment of displaced type II supracondylar fractures is controversial. Some authors recommend closed reduction and casting, while others recommend closed reduction and pinning. Closed reduction avoids iatrogenic surgical complications such as pin tract infection, nerve injury, and anesthetic related events. The purpose of this study was to determine the success of closed reduction and casting in the management of type II supracondylar humerus fractures. The cohort consisted of 24 patients (25 elbows) with displaced type II supracondylar humerus fractures. Type I and type III were excluded. Initial attempt at closed reduction and casting was performed under conscious sedation, and the patients were placed in an above-elbow cast, with 90-100 degrees of elbow flexion. X-rays were taken for the first two to three weeks, and fractures that lost reduction required secondary closed reduction and pin fixation.
The results of this study indicate that 18 of the 25 elbows, or 72%, maintained alignment. Only seven elbows lost fracture reduction on x-rays. Five of these seven underwent closed reduction and pinning, while the other two patients did not for a variety of reasons. No neurovascular complications or compartment syndromes were related to the closed reduction and casting or to the percutaneous pinning. Overall, 23 of the 25 elbows had a satisfactory outcome, and two elbows were unsatisfactory. The outcome did not appear to be related to the method of treatment.
The results from the study support an initial attempt at closed reduction and casting and type II extension supracondylar fractures. Approximately ¾ of the patients were able to maintain the reduction in the cast. Follow-up revealed an acceptable outcome. The five patients that underwent secondary reduction and pinning due to loss of reduction were reduced without difficulty. The authors do stress the need for weekly radiographic checkup to ensure no loss of reduction that cannot be corrected with repeat reduction and pinning. Although the number of patients in this study is small, the results certainly support a nonoperative trial in the management of type II extension supracondylar elbow fractures.
J Pediatr Orthop 2004;24:380-384.