Figure 20.1
Examples of supracondylar humerus fractures with varying degrees of displacement
Lateral condyle fractures: If the fracture is non-displaced, place in long-arm cast. If the fracture is displaced, attempt closed reduction by applying a varus force to the elbow with the forearm in supination and the arm in extension. If the fracture reduces, place the arm in a long-arm cast.
Medial condyle fractures: If the fracture is non-displaced, place in long-arm cast. If the fracture is displaced, attempt closed reduction by applying a direct force at the medial elbow with the forearm in pronation and the arm in extension. If the fracture reduces, place the arm in a long-arm cast.
Radial head or neck fractures: If the fracture is nondisplaced or angulated less than 30°, the arm is immobilized with sling, long-arm splint, or long-arm cast (depending on the compliance of the patient) followed by early range of motion. If the fracture is angulated more than 30°, once of several described methods can be utilized. The Israeli method involves placing the elbow in flexion and with direct force over the radial head; the forearm is rotated into a pronated position. If the reduction is successful, the arm is immobilized in a long-arm cast in 90° of flexion.