Nonoperative treatment of displaced supracondylar fractures in children - Rigault type 2 fractures

Background Current opinion in the medical literature concerning displaced supracondylar fractures of the distal humerus recommends pinning because with flexion braces there is a risk of both secondary displacement and Volkmann syndrome. Patients and methods We analyzed 84 children with displaced supracondylar fractures. According to Rigault's classification, 30 children had grade 2 fractures, 21 had grade 3, 28 had grade 4 and 5 had multiple fragments, which were thus outside this classification. Fractures that could be reduced to a stable position under general anesthesia were treated with a posterior long arm splint with an average elbow flexion of 113 degrees (90-140). This technique was applied in 28 of the grade 2 fractures and in 4 of the grade 3 fractures, but in none of the grade 4 fractures. Results Of the 4 cases of Rigault grade 3 fractures treated nonoperatively, 3 had to be re-reduced and I needed an operation later on for varus correction. Of the 28 Rigault grade 2 fractures, 27 showed excellent results, and I had a good result. Nile advise nonoperative treatment in type 2 supracondylar fractures if stable reduction is achieved.