Gartland type IV supracondylar humerus fractures in children are characterized by complete periosteal disruption and multidirectional instability, frequently resulting in failure of standard closed reduction maneuvers. Persistent rotational instability is the primary factor leading to loss of reduction and the subsequent need for open reduction. Although open reduction is effective, it is associated with increased soft-tissue dissection, longer operative times, and a higher risk of postoperative stiffness and neurovascular complications. We describe a temporary lateral cortical pin-assisted closed reduction technique that facilitates controlled rotational correction while preserving lateral cortical alignment. After restoration of lateral cortical continuity under fluoroscopic guidance, a temporary lateral Kirschner wire is inserted to act as a hinge, stabilizing the reduction and allowing precise rotational adjustment of the distal fragment before definitive fixation. Definitive stabilization is then achieved with standard percutaneous pinning, most commonly using a lateral-only configuration. This technique is simple, reproducible, and may expand the indications for successful closed reduction, thereby reducing the need for open reduction in selected Gartland type IV supracondylar humerus fractures.
Emin C. Balci (Tue,) studied this question.