The Difficult Supracondylar Humerus Fracture: Flexion-Type Injuries

Although flexion-type supracondylar humerus fractures account for a minority of all supracondylar humerus fractures, they warrant special attention because of their relatively high rate of requirement for open reduction and their potential for ulnar nerve injury or entrapment. The severity of flexion-type supracondylar humerus fractures may be difficult to appreciate on initial radiographs; therefore, surgeons must have a high index of suspicion in the evaluation of a patient who has a suspected flexion-type supracondylar humerus fracture. Nondisplaced or minimally displaced flexion-type supracondylar humerus fractures can be treated with long arm casting. Displaced flexion-type supracondylar humerus fractures require surgical reduction and stabilization. The unique instability of and reduction position for flexion-type supracondylar humerus fractures make reduction and pinning more of a challenge compared with the more common extension-type supracondylar humerus fractures; therefore, special considerations are required in the surgical setup and planning for flexion-type supracondylar humerus fractures.