Supracondylar fracture fixation is an urgent operation to realign and pin a broken lower end of the humerus (upper arm bone) near the elbow in a child. It is one of the most common paediatric fracture operations.
Under X-ray guidance, the fracture is reduced (realigned) by manipulation. Two or three K-wires (thin metal pins) are passed through the skin, across the fracture, to hold it in position. The wires protrude through the skin and are bent over. A cast or splint is applied. The operation takes 30–60 minutes.
Surgery is needed for displaced supracondylar fractures (Gartland types II and III). These fractures can damage the brachial artery and nerves around the elbow, so prompt treatment is important.
Undisplaced fractures (Gartland type I) are treated in a cast or collar-and-cuff sling. Displaced fractures require surgical fixation.
This is an emergency or urgent procedure. Assessment of the nerve and blood supply to the hand is critical before and after surgery.
Excellent outcomes in most children. The fracture heals within three to four weeks and remodelling occurs with growth. Most children regain full elbow movement.
Superficial infection around the protruding wires. Usually managed with antibiotics.
A minor change in the angle of the arm at the elbow (cubitus varus). Usually cosmetic only.
The median, radial, or ulnar nerve may be injured by the fracture or during pinning. Most recover spontaneously.
The brachial artery may be damaged. Requires urgent assessment. If the hand is pink and warm, the artery is usually intact.
Increased pressure in the forearm muscles. Requires emergency surgery.
Healing in a rotated position. May cause cubitus varus (gunstock deformity).
Usually temporary. Children recover movement faster than adults.
General anaesthesia.
Cast or splint for three to four weeks. K-wires removed in clinic at three to four weeks (quick procedure, usually without anaesthesia). Most children regain full movement within six to eight weeks without formal physiotherapy.
X-ray at one week. Wire removal and X-ray at three to four weeks. Final review at six to eight weeks.
Displaced supracondylar fractures can damage the blood supply or nerves to the hand. Prompt reduction and fixation reduces the risk of these complications.
Wire removal is a quick procedure performed in clinic. Most children experience brief discomfort but tolerate it well.
Almost all children regain full elbow movement. Children heal and remodel much better than adults.