Supracondylar fracture with Steinmann pins

Case contributed by Dr Matt A. Morgan

Presentation

Monkeybar accident. Patient has been assessed in the emergency department and been evaluated by orthopedic surgery.

Patient Data

Age: Child
Gender: Male

Comminuted, mostly transverse, minimally-displaced supracondylar fracture.

Five intraoperative spot fluoroscopic views during fixation of a supracondylar fracture (type 2B: posterior periosteum intact). 

Closed reduction followed by three percutaneous Steinmann pins were through the fracture for fixation.

Postoperative radiograph after Steinmann pin placement through the supracondylar fracture. The pins are percutaneous.

Case Discussion

Type II and III pediatric supracondylar fractures are often treated with closed reduction and fixation with pins or wires. (Type I fractures are splinted, then casted).

In this case Steinmann pins were used for fixation. Some surgeon use a lateral pin technique (as above) and some use a crossed-pin approach.

Early complications include vascular compromise and peripheral nerve injury (e.g. ulnar nerve injury if a median pin approach is performed).

Late complications include malunion, particularly a malunion with a varus/valgus orientation. Pins occasionally can back out or become infected.

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