CLOSED REDUCTION Supracondylar Fractures

■ Traction is applied with the elbow in 20 to 30 degrees of flexion (TECH FIG 1A) to prevent tethering of the neurovascular structures over the anteriorly displaced proximal fragment. 

■ For severely displaced fractures, where the proximal fragment is entrapped in the brachialis muscle, the “milking maneuver” is performed (TECH FIG 1B). 

■ The soft tissue overlying the fracture is manipulated in a proximal to distal direction. 

■ Once length is restored, the medial and lateral columns are realigned on the AP image. 

■ Varus and valgus angular alignment is restored. 

■ Medial and lateral translation is also corrected. 

■ For the majority of fractures (ie, extension type), the flexion reduction maneuver is performed next (TECH FIG 1C). 

■ The elbow is gradually flexed while applying anterior pressure on the olecranon (and distal condyles of the humerus) with the thumbs. 

■ The elbow is held in hyperflexion as the reduction is assessed by fluoroscopy. 

■ Reduction is adequate if the following criteria are fulfilled: 

■ The anterior humeral line crosses the capitellum. 

■ The Baumann angle is 10 degrees or comparable to the contralateral side. 

■ Oblique views show intact medial and lateral columns. 

■ The forearm is held in pronation for posteromedial fractures. 

■ The forearm is held in supination for posterolateral fractures. 

■ For unstable fractures, the fluoroscopy machine instead of the arm is rotated to obtain lateral views of the elbow (TECH FIG 1D)