Radiographic Outcomes After Treatment of Pediatric Supracondylar Humerus Fractures Using a Treatment-Based Classification System

Objectives: To develop a radiographic method to categorize supracondylar fractures into four types that have logical treatment correlations. The new classification is described, illustrated, and then tested to see if it is reproducible, safe, and effective. Design: Clinical follow-up study. Setting: Level I trauma center. Patients: One hundred forty-one extension-type supracondylar fractures. Intervention: According to our system, a long arm cast without reduction was indicated for no or little displacement (Type I), closed reduction and long arm casting was indicated for minimal displacement (Type II), closed reduction and lateral pinning was indicated for moderate displacement (Type III), and closed or open reduction and medial-lateral crossed pinning was indicated for complete displacement (Type IV). Main Outcome Measure: Baumann's angle (anteroposterior) and the shaft-condylar angle (lateral). Results: No significant differences were observed among the four types with respect to changes in Baumann's angle or the shaft-condylar angle. No patient experienced a major loss of reduction and no iatrogenic ulnar nerve injury was encountered. Conclusions: The described treatment-based classification of extension-type supracondylar humerus fractures demonstrates promising results.