Closed reduction of flexion type supracondylar fractures
Flexion type supracondylar fractures account for less than 5% of all supracondylar fractures.
In this type of fracture, the traditional closed reduction maneuver, as described for extension type supracondylar fractures, cannot be used as the traditional hyperflexion of the elbow and dorsal pressure of the distal fragment displaces the fracture farther.
Be aware that, in the case of flexion type supracondylar fractures, the posterior periosteum is ruptured whereas the anterior periosteum is mostly intact.
In principle, the maneuver of reduction must be one of hyperextension. Once a good reduction has been obtained, it is best to stabilize the fracture with two K-wires. This allows the elbow to be brought back into a flexed position for cast immobilization. If the fracture is not fixed with K-wires, the elbow would have to be immobilized in uncomfortable hyperextension.
No single closed reduction technique is going to be universally successful. However, the modifications described below to the standard closed reduction technique will help in certain settings.
Note: An alternative method for reduction and fixation is the use of a lateral external fixation technique.