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