A 5-year-old child falls on an outstretched hand and develops swelling around the elbow. Radiograph shows a completely displaced supracondylar fracture (Gartland Type III) with the anterior humeral line (AHL) passing anterior to the capitellum. The immediate treatment priority is:
- A Closed reduction and above-elbow plaster cast with elbow flexed at 120°
- B Open reduction and internal fixation with plate and screws
- C Urgent closed reduction under anaesthesia with percutaneous Kirschner wire (K-wire) fixation and check of neurovascular status ✓
- D Overhead olecranon traction for 3 weeks
Correct answer: C. Urgent closed reduction under anaesthesia with percutaneous Kirschner wire (K-wire) fixation and check of neurovascular status
Explanation
Gartland Type III supracondylar fractures in children require urgent (within 6–8 hours if neurovascular compromise) closed reduction and percutaneous cross K-wire (or lateral divergent) fixation under general anaesthesia. Cast alone for a Gartland III fracture has unacceptably high rates of loss of reduction and malunion. Neurovascular status (anterior interosseous nerve, radial and brachial artery) must be assessed before and after reduction. Open reduction is reserved for irreducible fractures or open wounds.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.