A selective treatment approach to supracondylar fracture of the humerus in children.

The results of a "selective treatment" policy applied to 176 patients presenting with supracondylar fracture of the humerus are analyzed. As initial treatment 148 patients underwent closed reduction and casting, seven closed reduction and pinning, 17 olecranon traction, and four open reduction and pinning. Analysis of patients by fracture type and initial treatment demonstrated a satisfactory outcome in 46 of 75 type III fractures and in 37 of 48 patients with type II fractures treated by closed reduction and casting. Thus a policy of initially pinning all such type III fractures in our unit would mean that 61% of such fractures would be pinned needlessly. Of type II fractures 77% would be needlessly pinned if such a policy was applied to type II fractures. The current trend towards pinning of all type III supracondylar fractures is not supported by the data from this study.