Supracondylar fracture of the humerus in children. Further experience with a study in orthopaedic decision-making.

In a study of the results of each therapeutic act in the treatment program of displaced supracondylar fractures of the humerus, 108 consecutive children were analyzed. An initial attempt at closed reduction was noted in 101 cases, with the attempt successful in 61. Of these elbows, 19 were flexed at least 120 degrees following reduction, with all 19 maintaining reduction. Twenty-two of the remaining reduced fractures were splinted in less than 120 degrees of flexion; 19 lost reduction. Traction alone, via olecranon pin or skin, was unsuccessful in achieving reduction and unreliable in maintaining reduction once achieved. Crossed Kirschner wires, placed percutaneously or under direct visualization, were uniformly successful in maintaining reduction. From these data an algorithm has been constructed to facilitate objective decision-making in the treatment of this challenging fracture.