CLOSED REDUCTION Supracondylar Fractures
CLOSED REDUCTION
■ Traction is applied with the elbow in 20 to 30 degrees of flexion (TECH FIG 1A) 
to prevent tethering of the neurovascular structures over the anteriorly displaced proximal fragment.
to prevent tethering of the neurovascular structures over the anteriorly displaced proximal fragment.
■ For severely displaced fractures, where the proximal fragment is entrapped in the brachialis muscle, the “milking maneuver” is performed (TECH FIG 1B). 
■ The soft tissue overlying the fracture is manipulated in a proximal to distal direction.
■ Once length is restored, the medial and lateral columns are realigned on the AP image.
■ Varus and valgus angular alignment is restored.
■ Medial and lateral translation is also corrected.
■ For the majority of fractures (ie, extension type), the flexion reduction maneuver is performed next (TECH FIG 1C). 
■ The elbow is gradually flexed while applying anterior pressure on the olecranon (and distal condyles of the humerus) with the thumbs.
■ The elbow is held in hyperflexion as the reduction is assessed by fluoroscopy.
■ Reduction is adequate if the following criteria are fulfilled:
■ The anterior humeral line crosses the capitellum.
■ The Baumann angle is 10 degrees or comparable to the contralateral side.
■ Oblique views show intact medial and lateral columns.
■ The forearm is held in pronation for posteromedial fractures.
■ The forearm is held in supination for posterolateral fractures.
■ For unstable fractures, the fluoroscopy machine instead of the arm is rotated to obtain lateral views of the elbow (TECH FIG 1D)
