A 7-year-old boy falls on an outstretched hand. X-ray shows a supracondylar humerus fracture with posterior displacement of the distal fragment, with the anterior humeral line not intersecting the capitellum. The radial pulse is absent and the hand is pale. Gartland classification is Type III. Immediate management is:

• A Above-elbow POP cast for 3 weeks in urgent care
• B Vascular surgery consult first, then delayed fixation
• C Open reduction immediately without attempting closed reduction
• D Emergency closed reduction under general anaesthesia and percutaneous Kirschner wire fixation ✓

Explanation

Gartland Type III supracondylar humerus fracture (complete displacement, both cortices disrupted) with absent radial pulse and vascular compromise is an orthopedic emergency requiring immediate closed reduction under general anaesthesia and percutaneous K-wire fixation. The absent pulse usually recovers after fracture reduction in most cases (brachial artery is kinked or in spasm — 'pink pulseless hand'). If pulse remains absent after anatomical reduction, vascular exploration is indicated. Casting alone is inadequate for Type III. Open reduction is reserved for failed closed reduction or open fractures. Watchers 'observe vascular status while casting' risk Volkmann's contracture development.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.