As an SH IV injury there is a risk of physeal arrest or nonunion unless totally undisplaced, or, if displaced, an anatomical reduction and fixation are achieved.
Any step displacement in the joint should be avoided also to prevent joint incongruency. For these fractures the rules are the same as for adults.
To prevent secondary displacement, which would require an open procedure, closed fixation of a minimally displaced fracture can be performed with divergent K-wires, or a small lag screw.
Timing of treatment
Only severely displaced fractures with risk of secondary damage (eg, skin perforation by the pressure of the fragment) and open fractures are indications for emergency surgery.
There is evidence that in nonurgent cases a delay in treatment of up to 2-3 days has no negative effect on healing or outcome.
The following points influence the timing of the treatment:
- Availability of surgical resources, including an experienced surgeon and cannulated screw equipment
- The patient should be treated on a routine operating list, preferably the day after injury. In the meantime, plaster splint immobilization and elevation of the elbow joint is recommended for pain management