Pediatric Supracondylar Humerus Fractures: Evaluation and Management Approach in Resource-limited Settings

Supracondylar humerus fractures (SCHFs) are common injuries among children and typically occur after a fall on an outstretched hand. SCHFs may present with neurovascular injury specifically to the brachial artery and/or median nerve (or its deep motor branch), ulnar nerve, and/or radial nerve. Thorough examination of a patient's neurovascular status is imperative to appropriately guide treatment and determine whether a referral is needed. Minimally displaced SCHFs may be treated nonsurgically, whereas displaced injuries often require surgery. Displaced SCHFs may be treated nonsurgically with traction and splinting, but providers should expect a high rate of complications and notable disability. Of equal importance to consider is the status of the soft tissues. In resource-limited settings, such as rural or district hospitals, surgery for more severe SCHFs may not be feasible because of lack of fluoroscopy, implants, or staff adequately trained in musculoskeletal trauma. In these situations, referral to a hospital with increased resources and surgical capabilities is recommended when possible. We present an approach to the triage and treatment of SCHFs in various resource-constrained environments, broadly applicable to low- and middle-income countries.