Closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children: description of a new closed reduction technique for fractures with brachialis muscle entrapment.

A retrospective review of 43 displaced extension-type supracondylar humerus fractures in children was performed. Thirty-four fractures were completely displaced (type III). Ninety-one percent (39 of 43) of the fractures were managed by immediate closed reduction and percutaneous pinning. Ten type III fractures exhibited clinical or radiographic evidence of brachialis muscle penetration. A closed reduction maneuver designed to "milk" the entrapped brachialis muscle off of the proximal fracture spike was developed and was successful in all eight cases in which it was attempted. At mean follow-up of 35 months, 97% (38 of 39 patients) achieved a good or excellent result based on the Flynn grading scale.