Loss of Fixation of a Type IV Supracondylar Humerus Fracture Treated with Three Divergent Lateral Pins.

Supracondylar humerus fractures are common injuries encountered by orthopaedic surgeons. Closed reduction and percutaneous pin fixation is classically considered the standard of care treatment for these injuries, as this treatment method minimizes trauma to the soft tissues, are associated with few complications, and have a high rate of success. However, loss of fixation, when occurring, can lead to cosmetic, functional, and neurological complications. We present a case study of a displaced supracondylar humerus fracture initially treated with three lateral divergent pins that lost fixation and underwent subsequent surgical revision. •Failure to engage both the fracture fragment and the intact proximal shaft may lead to loss of fixation.•Rotating the fluoroscopy machine while keeping the elbow fixed allows for obtaining intraoperative imaging while minimizing the risk of fracture displacement or subsequent loss of fixation.•A trans-olecranon pin may be a helpful reduction tool in significantly unstable fracture patterns.•Casting should be considered for postoperative immobilization in Gartland Type III or Gartland IV fractures.