Short presentation on the technique of reduction of Flexion type of supracondylar fracture

1. Flexion Type of
Supracondylar Fracture
Prepared by Dr Madan Mohan B
Based on a JBJS Review
Anmol Sharma, MBBS, MS
Investigation performed at the Government Medical College and Hospital, Chandigarh, India
JBJS REVIEWS 2019;7(4):e6 · http://dx.doi.org/10.2106/JBJS.RVW.18.00114

2. • A flexion supracondylar fracture of the humerus is an uncommon
fracture in children and accounts for only 1% to 10% of all
supracondylar fractures.
• The injury is caused by a direct fall on the point of the elbow,
causing hyperflexion at the elbow, rather than by a fall on an
outstretched hand, which is the mechanism in an extension-type
fracture.
• The ulnar nerve is at higher risk of injury in this fracture by the
spike of the proximal fragment or by entrapment in the callus.

3. • This fracture is inherently unstable, leading to
difficulty in maintaining reduction intraoperatively and
difficult Kirschner wiring in the extension position in
which the reduction is achieved.
• Kirschner wiring can be done in a flexed position of
the elbow by utilizing a push-pull method, a
temporary transolecranon pin, or a Kirschner wire as a
joystick in the distal fragment to achieve and maintain
reduction before the insertion of the final pins.

4. Fig. 1-A Prereduction
with a rolled towel used
as a fulcrum. Fig. 1-B
Push with overreduction
into extension. Fig. 1-C
Pullback to align the
anterior humeral line
with the middle third of
the capitellum.