Although supracondylar humerus fractures are one of the most common fractures in children, there remains notable controversy regarding several treatment aspects. Controversial topics include fixation of ipsilateral forearm fractures, treatment of type II supracondylar humerus fractures, pin configuration, timing of operative intervention, and treatment of supracondylar humerus fractures with a vascular injury. Studies have supported both closed and open reduction for treating ipsilateral forearm fractures associated with supracondylar humerus fractures. For type II supracondylar humerus fractures, some studies support nonoperative treatment owing to risks associated with operative treatment such as pin-site infections. However, other studies support operative fixation because of the risk of loss of reduction or malunion with nonoperatively treated fractures. Pin configuration can affect the stability of fracture fixation. Biomechanically, the strongest configuration has been shown to be a crossed-pin fixation; however, placement of a medial pin increases the risk of iatrogenic nerve injury. Therefore, an ideal pin configuration must balance stability with safety. Which fractures should be treated emergently and which can safely be delayed until the next morning is also controversial. The definition of adequate perfusion of the arm with a supracondylar fracture is debated as well as how to treat patients with decreased perfusion. Although the topic is widely researched, there is still much to be learned about the ideal treatment of supracondylar humerus fractures in children.

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