Pediatric Supracondylar Humerus Fractures with Medial Column Comminution: Case-Based Guidance on Fixation Method and Varus Prevention

Abstract

Background: Supracondylar humerus fractures are the most common pediatric elbow injuries, and maintaining stable reduction is essential to prevent late complications such as cubitus varus. Medial column comminution is an often underrecognized factor that can compromise stability, even in fractures that appear minimally displaced. This report highlights the clinical importance of medial column comminution in pediatric supracondylar fractures and emphasizes surgical strategies to prevent varus deformity.

Case Report: Two pediatric cases with supracondylar humerus fractures were evaluated. The first case involved a minimally displaced fracture initially treated non-operatively, which subsequently developed cubitus varus due to medial column collapse. The second case presented with medial column comminution and was managed with closed reduction and percutaneous pinning. Stable fixation and maintenance of alignment successfully prevented postoperative collapse and deformity.

Conclusion: Medial column comminution is a key determinant of stability in pediatric supracondylar humerus fractures. Early identification and a tailored surgical approach, including valgus reduction and selective medial pinning when indicated, are critical to prevent collapse, maintain alignment, and avoid late varus deformity.