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Type II Supracondylar Frx

- Discussion:
    - if the frx needs a reduction, then the frx is not a type I but a type II;
    - posterior cortex remains intact, making it a greenstick frx;
    - technically a type II frx implies posterior displacement, but frequently there will also be medial impaction w/ varus angulation, and hence there will be an need for reduction and percutaneous pinning in order to avoid cubitus varus;

- Radiographs:
      - consider the need for contralateral elbow radiographs to help determine normal anatomy;

- Treatment:
      - these frx require adequate reduction for acceptable alignment;
            - requires use of GEA;
            - involves correction of angulation in the frontal and saggital planes;
            - reduction involves elbow pronation and flexion;
            - arm is immobilized in pronation and an appropriate amount of flexion which should not exceed 120 deg;
      - percutaneous pinning is being used more liberally than in the past;
            - chief indication for pinning is fracture which requires excessive elbow flexion for maintenance of reduction;
            - relative indication is excessive arm swelling which may interfere w/ maintenance of reduction;
            - because type II frx have an intact posterior cortex (w/ enhanced stability) consider use of 2 lateral pins (as opposed to medial and lateral pins);
                   - w/ 2 lateral pins, there is no risk to the ulnar nerve;
                   - pins may be parallel or crossed proximal to the frx site

Predictors of Failure of Nonoperative Treatment for Type-2 Supracondylar Humerus Fractures

Extension Type II Pediatric Supracondylar Humerus Fractures: A Radiographic Outcomes Study of Closed Reduction and Cast Immobilization

Factors predictive of early radiographic failure following closed reduction of Gartland Type II supracondylar humeral fractures

Type II Supracondylar Humerus Fractures: Can Some Be Treated Nonoperatively?

Natural History of Unreduced Gartland Type-II Supracondylar Fractures of the Humerus in Children: A 2-13 Year Follow-up Study