Surgical Management of Humeral Fractures

Pediatric Supracondylar Humerus Fractures

The American Academy of Orthopaedic Surgeons recommends closed reduction with percutaneous pin fixation for displaced fractures (Gartland types II and III) in pediatric patients 1, 2, 3, 4
Emergent closed reduction is indicated for patients with decreased hand perfusion, with open reduction reserved only if closed technique fails 5, 2, 6, 7
Open reduction becomes necessary when closed reduction cannot be achieved due to fracture pattern, soft-tissue interposition, or technical factors 5, 2, 6, 7
The AAOS guidelines provide a structured approach based on perfusion status, including absent pulses with cold, pale hand after reduction and pinning, which indicates open exploration of antecubital fossa to prevent limb loss 8, 6
Decreased perfusion pre-reduction requires emergent closed reduction should be attempted first 5, 2, 6, 7
Open reduction in pediatric cases is associated with greater elbow stiffness compared to closed reduction with pinning, though it shows lower rates of loss of reduction 2, 6, 7
Soft-tissue interposition preventing closed reduction is a factor to consider for open reduction 1
Time from injury (mixed evidence suggests surgery within 12 hours may reduce need for open reduction) is a factor to consider for open reduction 5, 6, 7, 4

Neurovascular injury requiring exploration is an indication for ORIF in humeral shaft fractures 8