Supracondylar Fractures Of The Humerus Research Articles

“A journey from doom to bloom” – A rare case of low-energy pediatric open supracondylar fracture of humerus with brachial artery laceration managed with “Orthoplastic Approach”

Supracondylar fracture of the humerus (SFH) is the most common fracture of the elbow in the pediatric population (60%). The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability, and commonly, it is associated with road traffic accidents (RTAs) and occupational injuries. However, brachial artery injury in the pediatric age group is not very frequent as in adults and commonly associated with SFH. Long-term sequelae of ischemia in the forearm such as Volkmann's ischemic contracture may prove disastrous. Early aggressive management in terms of exploration of the brachial artery is recommended by Blakey et al., to prevent such serious complications. Arterial injury ranges anywhere from vascular contusion and intimal damage, to complete arterial transaction. Low-velocity injuries such as falls or sports injuries can cause isolated Type 1 open fractures (Gustilo and Anderson classification of open fractures). Open supracondylar fracture complicated by brachial artery laceration is usually seen in high-velocity injuries such as RTA and is usually a part of multiple injuries sustained in such patients. However, in search of literature, we have not found an isolated Type 3 open supracondylar fracture with brachial artery laceration following a fall from a speeding bicycle, which is considered as a low-energy trauma. This patient was managed with reduction and fixation of the fracture with crossed K-wires and repair of the brachial artery with interpositional reversed saphenous vein graft to save the limb.

The tansen technique – A new, easy, reliable, safe and cost effective, technique in closed reduction and percutaneous fixation of type 3 supracondylar fracture of the humerus in children

Introduction: Closed reduction and internal fixation with K wires is the standard of care for Gartland type III supracondylar fractures of children since they are too unstable for nonoperative treatment. Occasionally closed reduction of these fractures could be difficult using standard technique warranting open reduction which is associated with additional complications. We report a new intrafocal reduction technique and its results which can be used to reduce difficult supracondylar fractures reliably thus avoiding open reduction and its complications in most instances. Materials and Methods: Consecutive series of twenty-one patients who were treated successfully using intrafocal reduction (Tansen) technique from January 2014 to December 2015 were followed up for minimum of 6 months. Duration of operation, any intraoperative technique-related complication, and number of intraoperative image intensifier images were reviewed. Children were followed up at 3 weeks, 6 weeks, 3 months, and 6 months for the adequacy of reduction, for loss of reduction of fixation and fracture healing as well as a range of motion, complications, and functional outcome using Flynn's criteria. Results: The average operation time was 30.5 ± 10.5 min. The average number of intraoperative images was 15 ± 5. The average time and number of intraoperative images were not affected by the experience of the surgeon. Average healing was 6.1 ± 2 weeks. All patients achieved a satisfactory cosmetic and functional result. There was no significant loss of initial reduction on follow up. The minor complication rate was 16%. There was no technique-specific complication. Conclusion: Our simple intrafocal technique using artery forceps – “Tansen Technique” – gives an acceptable reduction in difficult supracondylar fractures which would otherwise require open reduction. It is cost-effective, consistent, has a short learning curve, and is a safe technique with potential use in day-to-day practice.

Supracondylar Humeral Fracture Documentation: A Performance Improvement Study.

Supracondylar fractures of the humerus (SCH) are the most common fractures about the elbow in children that require operative stabilization. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. It also is of prime importance for justification or defense of our care should this arise. One of the common concerns in transition from written documentation to an electronic medical record (EMR) is availability of proper documentation. We sought to develop an established EMR protocol to streamline and improve proper care and documentation for SCH fractures. This was in response to poor documentation in an initial retrospective evaluation. Documentation before and after the implementation of a clinical pathway were compared. A retrospective chart review was used to collect documentation information before the implementation of the clinical pathway and a prospective study design was used to collect information after the implementation of the clinical pathway. Proportions of preclinical and postclinical pathway documentation were compared before and after the implementation of the clinical pathway using a χ test, or the Fisher exact test for measures in which at least 20% of the expected frequencies were <5. A 2-sided 0.05 α level was used to define statistical significance. We saw an improvement in documentation after implementation of the clinical pathway, with statistically significant differences in nursing preoperative, physician preoperative, and physician postoperative. Nursing postanesthesia care unit, nursing postoperative, and physician clinic follow-up trended toward improvement but did not meet statistical significance. Although we did see improvement, we still did not meet ideal 100% documentation in all categories. Documentation is crucial to good medical care and legal defense should any arise. The implementation of a clinical pathway demonstrated significant improvement by physicians and nurses. Although overall improvement was obtained, there were areas associated with EMR identified that still require further improvement. Level III.

Is a radiograph needed one week after internal fixation of a supracondylar humeral fracture?

Displaced supracondylar fractures of the humerus (SCFH) require surgical treatment, most commonly closed reduction with pin fixation. Postoperative displacement following pin fixation is uncommon. Routinely, an early follow-up visit with a radiograph was recommended after fixation of SCFH. The aim of this study was to examine the rate of displacement of SCHF treated with pin fixation using objective radiologic measurements and to determine the need for the early follow-up radiographs. We retrospectively reviewed 161 patients with displaced SFCH treated surgically. The primary outcome measure was loss of reduction (LOR). We examined patient and fracture characteristics and postoperative complications. LOR was defined as a change of 5° or more in measurement of Bauman's angle or the lateral capitellohumeral angle. After applying exclusion criteria, the study group consisted of 131 patients; 87 (66.4%) were male; the left limb was involved in 76 patients (58%); 98 were classified as Gartland type 3 (74.8%); 118 patients had extension type fractures (90%); complications included nerve injury in 32 patients (24.4%), mostly involving the ulnar nerve (17, 13%). Pin-tract infection occurred in four patients (3%). LOR was found in five patients (3.8%). In all these patients, there was evidence of inadequate fixation in the intraoperative radiographs. When adequate fixation is obtained intraoperatively, the next follow-up radiograph is recommended after 3 weeks, at the time of pin removal.

Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness. &lt;/p&gt;

A clinical study of surgical management of paediatric humeral supracondylar fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Injury to the supracondylar region of the humerus and complete displacement of the fragments occurs in many of the cases when children usually fall while playing. This is most common fracture seen in children, makes up to 60% of all elbow injuries. Early intervention results in excellent reduction and avoids complications. Concomitant vascular and nerve damages may occur. Open reduction and internal fixation is a helpful option for the treatment of supracondylar facture of humerus in children.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Forty children who presented with displaced supracondylar fracture of the humerus were treated with open reduction and internal fixation with Kirschner (K) wires after thorough pre-operative investigation during the course of the study. Children below the age of 13 were selected irrespective of the sex.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Good results were obtained in 60% of the patients, fair in 30% and poor in 10%. The poor results were due to the open fracture and in two cases the patient presented very late to the hospital. Complications such as nerve injuries, vascular injuries, infections were noticed in the study. Four patients had cubitus varus and twelve patients had flexion loss on follow-up study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Open reduction and internal fixation with K wire is an easy, simple, inexpensive method, which has good outcome.&lt;/p&gt;

A study on management of paediatric supracondylar humerus fractures with lateral percutaneous Kirschner wire fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supracondylar fracture of the humerus in children is a common injury encountered in orthopaedic practice. Undisplaced fractures can be managed conservatively, however displaced fractures need proper reduction and adequate fixation for attainment of optimal functional and cosmetic outcomes. The purpose of this study was to evaluate the effectiveness of lateral percutaneous Kirschner (K) wire fixation in the management of displaced supracondylar fractures in relation to achievement of union and functional results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted on 70 patients of either sex with an average age of 5.98 years, presenting to the Orthopaedic Department of S.H.K.M. Government Medical College Hospital, Nalhar, Nuh, Haryana between February 2016 and February 2018, with displaced supracondylar fractures of humerus. All the patients were managed by closed reduction and percutaneous lateral K wire fixation. The patients were followed up for a period of 1 year. The patients were analyzed for union and functional results.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the fractures united with an average time of union of 3.8 weeks. Functional results were assessed using Flynn’s criteria, which were excellent in 58 (82.86%), good in 7 (10%), fair in 3 (4.28%) and poor in 2 (2.86%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus results of our study demonstrate that the lateral percutaneous K wire fixation is a safe and effective method of treatment of displaced paediatric supracondylar humerus fractures.&lt;/p&gt;

Incidence, Risk Factors, and Timing of Compartment Syndrome in Pediatric Patients with Supracondylar Fractures of the Humerus

Incidence, Risk Factors, and Timing of Compartment Syndrome in Pediatric Patients with Supracondylar Fractures of the Humerus

The effects of intraoperative fracture injection of bupivacaine on postoperative opioid consumption when treating supracondylar fractures of the humerus

Objective: The current opioid epidemic is a national problem and an increasing concern for pediatric orthopaedic patients. The use of non-opioid methods to reduce pain may help curb the over-prescribing and overuse of opioid medications. The present study aims to compare the effects of an intraoperative bupivacaine fracture injection on postoperative opioid consumption when treating supracondylar fractures of the humerus. Methods: 42 …

Intrafocal joystick technique for closed reduction and percutaneous fixation of late-presenting supracondylar fractures of the humerus

Background: Pediatric supracondylar humeral fractures are common and challenging injuries. The preferred approach is early closed reduction and percutaneous pinning; however, this fails in up to 25% of patients, and conversion to open reduction, especially in late-presenting patients, has been reported in 3% to 46% of patients due to severe swelling or skin problems around the elbow. This study presents a reduction technique that uses a temporary intrafocal Kirschner wire to allow indirect and more effective manipulation of the distal fragment, facilitating closed reduction in difficult situations. Methods: This study retrospectively evaluated the results of an intrafocal joystick technique that was used to aid closed reduction in 15 patients with late-presenting, displaced supracondylar humeral fractures with unfavorable soft-tissue conditions around the elbow. The mean patient age was 6±2.7 yr and the mean injury-to-surgery interval (delay) was 4±2.7 days. Baumann’s angle, humerocapitellar angle, the anterior humeral line-capitellum relationship were used for radiographic evaluation of the initial reduction and throughout the follow-up that lasted for a mean of 9.4±3.6 mo. The functional and cosmetic outcomes were assessed according to Flynn’s criteria and the Mayo Elbow Performance Index. Results: None of the patients could be successfully treated with the standard method. The intrafocal joystick technique succeeded in achieving acceptable closed reduction in 12 of 15 patients; the remaining three patients required open reduction and internal fixation. All fractures united, and wires were removed at a mean of 5.4±1.6 wk. Functional range of motion was regained after a mean period of 7.2±3.5 wk, while full elbow range of motion was regained after a mean period of 12.2±3.5 wk. According to Flynn’s criteria and the Mayo Elbow Performance Index, all patients had an excellent result. Conclusions: The intrafocal joystick technique for closed reduction and percutaneous fixation of irreducible supracondylar fractures of the humerus in certain difficult situations can effectively and safely achieve satisfactory radiographic and functional outcomes and decrease the need for conversion to an open reduction. Open reduction and internal fixation are essential in some patients but should only be used after all techniques of closed reduction and percutaneous fixation have failed. Level of Evidence: Level III retrospective.

Paediatric supracondylar humerus fractures.

This article gives a practical guide to the management of supracondylar fractures of the humerus in paediatric patients, from initial presentation to definitive treatment. It reviews the optimal management of this common and serious injury based on current evidence including the British Orthopaedic Association Standards for Trauma (BOAST) 11 standard.

The Flexion-Type Supracondylar Humeral Fracture in Children: A Review.

» A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures.» The injury is caused by a direct fall on the point of the elbow, causing hyperflexion at the elbow, rather than by a fall on an outstretched hand, which is the mechanism in an extension-type fracture.» The ulnar nerve is at higher risk of injury in this fracture by the spike of the proximal fragment or by entrapment in the callus.» This fracture is inherently unstable, leading to difficulty in maintaining reduction intraoperatively and difficult Kirschner wiring in the extension position in which the reduction is achieved.» Kirschner wiring can be done in a flexed position of the elbow by utilizing a push-pull method, a temporary transolecranon pin, or a Kirschner wire as a joystick in the distal fragment to achieve and maintain reduction before the insertion of the final pins.

Open reduction and internal fixation with k-wire in type III supracondylar fracture of humerus in children by posterior approach

Background: Supracondylar fractures of humerus are the most common fractures seen in children. Severely displaced supracondylar fractures of the distal humerus in children are a challenging problems. Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and involvement of neurovascular structures. Open reduction and internal fixation is applied when closed reduction fails to give satisfactory reduction. The aim of the study was to determine the cosmetic and functional results following open reduction and internal fixation with k-wire for type III supracondylar fractures of the humerus by posterior approach. Method: Twenty cases of type III supracondylar fractures of humerus were included in the study. The mean age of the patients was 8.4 yrs (ranges from 5-14 years). The male to female ratio was 2:1 and left side was involved in 14 cases and 6 had right sided injuries. All fractures were of extension type (gartland, s type III). Open reduction and internal fixation with k-wire was performed by posterior approach. K-wires were removed between 3- 4 weeks post operatively and follow up was done at 6wks, 12 wks, 6 months and 12 months. The results were graded using the criteria described by Flynn et al.Results: Excellent results were achieved in 11 pts (55%), good in 4 pts (20%), fair in 2 pts (10%), while poor results were seen in 3 pts (15%).Conclusion: Open reduction and internal fixation with k-wires by posterior approach in type III supracondylar fractures of humerus in children is satisfactory.

Correction of cubitus varus with lateral closed wedge osteotomy and cross k-wire fixation: results of a prospective series of 19 patients

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy. Various complex corrective osteotomies have been described in literature with no consensus. We conducted this study to evaluate whether a simple lateral closed wedge osteotomy can give predictably good results in these patients. Materials and Methods: Nineteen children with malunited supracondylar fracture humerus leading to cubitus varus deformity underwent lateral closed wedge osteotomy, which was fixed with cross K-wires. Patients were evaluated for carrying angle, elbow range of motion, complications if any, and radiological correction of humeroulnar angle. Results: Osteotomy healed in all patients by 8 weeks (range 4–8 weeks, mean of 5.5 weeks). Excellent correction was achieved in 18 patients, whereas one patient had inadequate correction. Preoperative varus ranging from 10° to 30° (average – 17°) improved to 0°–12° valgus (average-8°). Two patients had minor complications in the form of pin tract infections which resolved with local care and antibiotics. There was no loss of correction or pin loosening. Sixteen patients had excellent result, whereas three patients had fair result as per Bellemore's criteria. Conclusion: Complex three-dimensional osteotomy is not always necessary for cubitus varus correction and a simple lateral closed wedge osteotomy fixed using cross K-wires can give good results with proper planning and execution.

Clinical results of closed versus mini-open reduction with percutaneous pinning for supracondylar fractures of the humerus in children: A retrospective case-control study.

To compare the clinical outcomes of 2 procedures, closed or mini-open reduction with percutaneous pinning (ORPP), for the treatment of supracondylar fractures of the humerus in children.Patients aged less than 15 years who had undergone surgery for supracondylar fracture of the humerus between 2004 and 2013 were identified. The case records and radiographs from 34 patients were reviewed. Twenty-one patients had undergone closed reduction followed by percutaneous pinning (CRPP), while 13 had undergone mini-open reduction through the anterior approach with percutaneous pinning (mini-ORPP). The average age of the patients at the time of surgery was 5.4 (1–13) years in the CRPP group and 5.4 (2–9) years in the mini-ORPP group. The average age of the patients at the time of surgery was 5.4 (1–13) years in the CRPP group and 5.4 (2–9) years in the mini-ORPP group. Based on the Gartland classification system, the CRPP group included 12 type 2 and 9 type 3 fractures, while the mini-ORPP group included 4 type 2 and 9 type 3 fractures. The average postoperative follow-up duration was 8 (3–21) months in the CRPP group and 10 (3–10) months in the mini-ORPP group. The investigated parameters were postoperative complications, radiographic evaluation, and clinical evaluation, including range of motion (ROM) and Flynn's criteria. To evaluate the deformity of the humerus, Baumann's angle and the carrying angle (CA) were calculated on anteroposterior radiographs.Although no patient showed loss of reduction, deep infection, or neurovascular complications, 1 patient in the CRPP group had a cubitus varus deformity. The average CA loss in the injured elbow compared with the CA of the contralateral side was significantly larger in the CRPP group than the mini-ORPP group. In accordance with Flynn's criteria, the results in the CRPP group were excellent in 12 patients, good in 8, and poor in 1; the results in the mini-ORPP group were excellent in 12, and good in 1.To eliminate the possibility of postoperative cubitus varus deformity, the mini-ORPP is the optimal procedure for supracondylar fracture of the humerus in children.

Classification of Pediatric Supracondylar Fractures: Comparison between the Gartland and the Lagrange & Rigault Classifications

Background The supracondylar fracture of the humerus is one of the most common fractures in pediatric age. Many classifications were proposed, with Gartland being the most widely used one and Lagrange and Rigault (L&amp;R) the most used in French-speaking countries. Objectives The goal of this study was to compare the Wilkins-modified Gartland classification with the L&amp;R classification in terms of reproducibility. Methods Three observers with similar training levels classified 35 fractures according to both classifications twice to evaluate both intra and interobserver variation. Results The mean intraobserver variation was 0.78 and 0.77 for Gartland and L&amp;R classifications, respectively, and the mean interobserver variation was 0.55 and 0.62 for Gartland and L&amp;R classifications, respectively. Conclusions Both classifications reveal adequate to usage in clinical and investigational practices, which is consistent with the literature.

Management of supracondylar fractures of the humerus in children.

Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years.Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries.Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present.Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively.Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction.Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion.Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049

The results of closed reduction and percutaneous pinning in supracondylar fractures of humerus in children

Introduction: Supracondylar fracture of the humerus is the most common type of elbow injury in children, accounting for 60% of fractures in this area and represent about 3% of all the fractures in children. Treatment of supracondylar fractures is fraught with many complications including Volkmann’s ischemic contracture, nerve injury, arterial injury, myositis ossificans and cubitus varus deformity. Closed reduction and percutaneous was initially described by Swenson and later popularized by Flynn et al. Materials and Methods: The present study consisted of thirty displaced supracondylar fractures of the humerus in children. All the patients were under thirteen years of age treated in Orthopaedics Department of Government Medical College, Jammu during the period of May 2015 to Oct. 2017.Fractures were classified according to Gartlands classification and all the displaced fractures were treated by closed reduction and percutaneous pinning under c-arm. Results: The minimum age was 4.5 years and maximum age was 11 yrs. Males outnumbered females in all the age groups. According to Flynn's criteria, excellent results were reported in 23 cases (76.7%), good in 4 cases (13.3%), fair in 2 cases (6.7%) and poor in one case (3.3%). The time of Radiological evidence of union was around 3-5 weeks. The average time of regaining normal range of motion was 9 weeks. Conclusion: This study shows that close reduction and percutaneous pinning under image intensifier is the treatment of choice in severely displaced supracondylar fractures of the humerus in children.

To compare the functional outcome of cross k-wires v/s lateral k-wires in Gartland type-III supracondylar humerus fracture in paediatric age groups

Introduction: Supracondylar fractures of the humerus are very common fractures in pediatric age groups. If displaced, preferred treatment is close reduction with percutaneous K-wire fixation. This study compares the functional outcome of cross k-wires v/s lateral k-wires in Gartland type III supracondylar humerus fractures in paediatric age groups. Materials and Methods: 30 cases of supracondylar fractures of the humerus gartland type III in children operated with closed reduction and pinning of which 15 were of lateral and 15 were of cross k wires group from January 2015 to June 2017 with minimum 4 months follow-up period were consideredResults: Functional outcome of the patients was assessed by Flynn’s criteria. Results were excellent 13.33%, good 40% fair 46.6% in cross k wire group and excellent 6.6%, good 46.6% fair 40% and poor 6.6% in lateral k wire groupConclusion: Both lateral entry pin fixation and crossed pin fixation are effective in the treatment of gartland type III extension supracondylar fractures of the humerus in children.

Treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of humerus in children

To analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children. Between January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years (mean, 5.7 years). The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours (mean, 4.6 hours). All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed. The operation time was 16-52 minutes (mean, 32 minutes). The perspective frequency was 4-17 times (mean, 6.7 times). The hospitalization time was 3-7 days (mean, 4 days). All the 45 cases were followed up 8-20 months (mean, 12 months). The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in 1 case, and the excellent and good rate was 92.3%. Gartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.