Open fractures of the limbs in children and adolescents

Modern Treatment of Supracondylar Humeral Fractures in Children

Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of complicated supracondylar humeral fractures (Gartland types II and III). Gartland type II and III fractures are most frequently treated with closed reduction and percutaneous Kirchner-wire pinning or open reduction with K-wire pinning, depending on the degree of displacement and the orthopedic surgeon's preference. Most studies recommend avoiding open reduction because of prolonged hospitalization and higher rates of complications. Orthopedic surgeons have different opinions regarding the Kirschner pin placement technique. Studies suggest that only lateral pinning is safe and effective, but medial and lateral pinning is proven to give more stability; there is always a risk of iatrogenic ulnar nerve damage during surgery. Modern treatment of supracondylar humeral fracture in children should focus on minimally invasive techniques and avoid open reduction, when possible, to ensure the best outcome for the patients. This scoping review's purpose is to gather the available information on the topic in one place and to underline the lack of clear protocols.