Oblique Supracondylar Humerus Fracture

Abstract

Oblique supracondylar humerus fractures represent a subset of supracondylar fractures with additional inherent instability due to their fracture orientation and may present with significant shortening and rotational deformity (Zorrilla et al., Int Orthop 39(11):2287–2296, 2015). Closed reduction and percutaneous fixation of closed injuries remains the standard of care, and open reduction is rarely necessary. However, special attention is required to the medial and lateral columns during reduction and fixation, as well as to the posterior cortex, if there is also a sagittal oblique component to the fracture (Jaeblon et al., J Pediatr Orthop 36(8):787–792, 2016). Depending on the obliquity of the fracture, the lateral-entry pinning technique may need to be modified (Feng et al., J Pediatr Orthop 32(2):196–200, 2012; Wang et al., J Pediatr Orthop 21(6):495–498, 2012). After successful closed reduction, Kirschner wire fixation with 0.062 in or 0.078 in pins in either crossed-pin or lateral-only configuration is acceptable, with the goal of maximizing pin spread at the fracture site and adequate fixation of the medial and lateral columns (Iobst et al., J Orthop Trauma 32:e492–e496, 2018; Bahk et al., J Pediatr Orthop 28(5):493–499, 2008). The postoperative course is comparable to transverse supracondylar fractures, with x-rays 1–1.5 weeks postoperatively to ensure maintenance of alignment and pin removal in the office at 3–4 weeks post-op (Reisoglu et al., Acta Orthop Traumatol Turc 51(1):34–38, 2017).