These are fractures of the end part of the humerus bone near the elbow. They are the most common type of elbow fracture in children. We tend to be aggressive in re-aligning the bone as we do not want children developing a crooked elbow.
Some of these fractures are undisplaced (crack only) and these do not require surgery. These children are managed with immobilization, often with a partial cast, placed in the clinic or emergency department. We call these "Type I" supracondylar fractures.
Supracondylar fractures can also be displaced with the end portion of the bone going into angulation. We call these "Type II fractures". In Canada we take these children to the operating room, reposition the fracture by manipulation alone and then place pins through the skin for approximately 3 weeks to maintain the correct position for healing along with a partial cast. The pins are removed in the clinic.
The last group of supracondylar fractures are the severe ones or 'Type III' where the ends of the bone are widely displaced (not even touching each other). Sometimes children with this severe type of supracondylar fracture can present to the emergency department with deficits in blood supply or nerve function. These take some effort and skill to get repositioned with manipulation alone and very occasionally they require an incision to explore nerves, blood vessels, and to get the fracture repositioned. These patients along receive pins through the skin to maintain the correct position while healing occurs.