A novel percutaneous intrafocal reduction technique for brachialis penetrating irreducible type 4 supracondylar humerus fracture

Abstract

Type 4 supracondylar fractures are challenging to treat. Closed reduction may become impossible due to brachialis muscle penetration and devastating results like a neurovascular injury that may occur during recurrent manipulations. We here report an intra-focal percutaneous reduction technique for maintaining closed reduction. An extensively posterior displaced type 4 supracondylar fracture with a dimple at the antecubital fossa and an extensive ecchymosis is presented. During surgery, we could not obtain closed reduction with the milking maneuver. We inserted an intrafocal K-Wire from the posterior side into the fracture site. With the levering of the wire, the dimple disappeared, after which we maintained the anatomical reduction and fixed the fracture with two lateral K-wires. Neither complication nor residual deformity was observed during postoperative follow-up. To show the exact long-term effects and the safety of this procedure, we need more fractures with brachialis penetration operated on by the described technique.