Management of Pediatric
Supracondylar Humerus Fractures
Abstract
Michael H. Heggeness, MD
James O. Sanders, MD
Jayson Murray, MA
Ryan Pezold, MA
Kaitlyn S. Sevarino, MBA
Copyright the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
e49
Methods
The AAOS uses the RAND/UCLA
Appropriateness Method to develop
AUCs.1 The process includes the
Indications and
Classifications
Table 1 provides the list of patient
indications and classifications developed by the PSHF AUC panels.
Treatments
The following treatments are addressed within the PSHF AUC: (1)
immobilization with a cast or splint
without reduction; (2) reduction with
subsequent casting at 70 to 90; (3)
reduction with subsequent casting
at .90; (4) closed reduction with
pinning and immobilization with lateral pinning and three timing options
consisting of emergent (as soon as
possible [ASAP], within medical status of patient and organization of
staff), urgent (patient is admitted as
an inpatient admission, and admitted
to the operating room [OR] when
medical status and staff are available),
and outpatient; (5) closed reduction
with pinning and immobilization with
cross pinning and three timing options consisting of emergent (ASAP,
within medical status of patient and
organization of staff), urgent (patient
is admitted as an inpatient admission,
and admitted to the OR when medical status and staff are available), and
outpatient; (6) open reduction and
pinning and immobilization and three
These appropriate use criteria were approved by the American Academy of Orthopaedic Surgeons on September 5, 2014.
The complete Appropriate Use Criteria for Management of Pediatric Supracondylar Humerus Fractures includes all tables, figures, and
appendices, and is available at http://www.aaos.org/research/Appropriate_Use/PSHF_AUC.pdf.
Management of Pediatric Supracondylar Humerus Fractures AUC Writing Panel: Fizan Abdullah, MD, PhD; Matthew Halsey, MD; Christine
Ho, MD; Col. Kathleen McHale, MD, MSEd, FACS; Kevin McHorse, PT, SCS, Cert. MDT; James F. Mooney, MD; Kishore Mulpuri, MD;
David G. Nelson, MD; Matthew Oetgen, MD; Larry Pack, MD; Laurel H. Saliman, MD; John M. Stephenson, MD; Yi-Meng (Beng) Yen, MD,
PhD, FAAP. Review Panel: Donald Bae, MD; Holly J. Benjamin, MD; Dale Blasier, MD, FRCS(C), MBA; Patrick Bosch, MD; Gregory J. Della
Rocca, MD, PhD, FACS; Eric Edmonds, MD; Hilton Gottschalk, MD; Daniel Green, MD, MS; Sumit Gupta, MD; James Hanley, III, MD;
Daniel Hely, MD; Stephanie Holmes, MD; Pooya Hosseinzadeh, MD; Charles J. Hyman, MD; Mark Kraus, MD; Walter Krengel, MD; Kevin
Little, MD; John Loiselle, MD, FAAP; John Lovejoy, MD; Stephen A. Mendelson, MD; Joshua Murphy, MD; Sara Rasmussen, MD, PhD; Jeff
Schunk, MD; Richard M. Schwend, MD; Mauricio Silva, MD; Vikas Trivedi, MD, DNB (Ortho), MNAMS (Ortho), FASIF; John Lovejoy, MD;
Douglas Lundy, MD. Voting Panel: Jeffrey O. Anglen, MD; Teresa Cappello, MD; Robert B. Carrigan, MD; Prasad Gourineni, MD, MS;
William L. Hennrikus, MD; Danielle Katz, MD; Annalise N. Larson, MD; Kevin Latz, MD; William M. Mirenda, Jr., MD; Norman Y. Otsuka,
BSc, MSc, MD; Min Jung Park, MD, MMSc; Peter Darrell Pizzutillo, MD; Brian Snyder, MD, PhD; Dale P. Woolridge, MD, PhD. Moderators:
Michael H. Heggeness, MD and James O. Sanders, MD. AAOS Staff: Deborah S. Cummins, PhD, Jayson Murray, MA, Ryan Pezold, MA,
Peter Shores, MPH, Ann Woznica, MLS, Kaitlyn Sevarino, MBA, and Yasseline Martinez.
e50
Copyright the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
Table 1
Figure 1
Nerve injuries
Soft-tissue envelope
Classification
Type 1: nondisplaced
Type 2: extension type with cortical
continuity of posterior cortex
Type 2: extension type with cortical
continuity of posterior cortex with varus/
valgus angulation
Type 3: extension type with no cortical
continuity
Transphyseal fracture
Flexion-type fracture
Nonperfused hand (cold, white, and
capillary refill .3 s) without palpable
distal pulse
Perfused hand (warm, pink, and capillary
refill ,3 s) without palpable distal pulse
Perfused hand (warm, pink, and capillary
refill ,3 s) with palpable distal pulse
Associated nerve injury present
Associated nerve injury absent
Open: appears uncontaminated
Open: concern for contamination and/or
significant soft-tissue injury
Closed
Typical
Severe swelling, ecchymosis, and/or
pucker sign (indentation of skin at the
fracture site)
Results of Appropriateness
Ratings
Of 3,080 total voting items (220
patient scenarios, 14 treatments),
678 voting items (22%) were rated as
appropriate, 431 voting items (14%)
were rated as may be appropriate,
Reference
AUC Mobile Application
As part of the dissemination efforts
for the PSHF AUC, this web-based
Copyright the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
e51