Management of Supracondylar Fractures in Children

Classification and Treatment

The Gartland classification system is widely used to classify supracondylar fractures in children into three types based on the degree of displacement, which determines the therapeutic management and prognosis 1
The American Academy of Orthopaedic Surgeons recommends conservative treatment with immobilization using a posterior splint or sling for non-displaced fractures 1
For partially displaced fractures, the American Academy of Orthopaedic Surgeons recommends closed reduction and percutaneous pin fixation with clavos 1
For completely displaced fractures without contact between fragments, the American Academy of Orthopaedic Surgeons recommends closed reduction and percutaneous pin fixation with clavos 1
Closed reduction with percutaneous pin fixation shows more favorable results in preventing cubitus varus and improving Flynn's elbow criteria compared to conservative treatment, according to the American Academy of Orthopaedic Surgeons 1

Complications such as neurovascular compromise, cubitus varus, compartment syndrome, and pin tract infection should be monitored, especially in type III fractures, according to the American Academy of Orthopaedic Surgeons 1
Preoperative neurovascular evaluation is crucial, especially in type III fractures, although there is no specific recommendation from a clinical guideline society in this article 1
The American Academy of Orthopaedic Surgeons recommends using an arm sling for immobilization and early mobilization (at 1 week) to reduce pain without compromising outcomes, with adequate instruction for self-directed exercise programs 1
Adequate self-directed exercise programs can achieve satisfactory outcomes, although there is insufficient evidence to recommend routine supervised physical therapy, according to the American Academy of Orthopaedic Surgeons 1
Optimal timing for allowing unrestricted activity remains unclear and should be based on clinical and radiographic evidence of healing, as per the American Academy of Orthopaedic Surgeons 1

Closed reduction with percutaneous pin fixation is the preferred treatment for displaced supracondylar fractures, providing better outcomes regarding prevention of deformity and improved functional criteria, according to the American Academy of Orthopaedic Surgeons 1
Urgent surgical management with closed reduction and pin fixation is recommended for supracondylar fractures with large hemarthrosis, followed by exploration of the antecubital fossa if vascular compromise persists after reduction, as per the American Academy of Orthopaedic Surgeons 1
Immediate surgical exploration of the antecubital fossa is mandatory in cases where vascular compromise persists after reduction, due to the risks of inadequate perfusion, including limb loss, ischemic muscle contracture, nerve injury, and functional deficit, according to the American Academy of Orthopaedic Surgeons 1

Early finger motion is encouraged to minimize stiffness, although the exact protocol may vary depending on the individual case 1
Monitoring for pin tract infection, compartment syndrome, neurovascular status, and loss of reduction is essential, especially in cases with vascular compromise, as delaying treatment can lead to catastrophic limb loss 1
Assess for signs of vascular compromise, including absent wrist pulses, cold and pale hand, decreased perfusion, antecubital ecchymosis, and excessive swelling, in patients with supracondylar fractures, and reassess vascular status immediately after reduction 1