- The patient is healthy enough to undergo surgery if indicated.
- A thorough history and physical examination of the patient has been conducted with special attention to the integumentary system, other injuries, neurologic and vascular exam and other medical problems. If the patient is too young or incapable of cooperating, this will be noted in the patient record.
- Adequate radiographs have been obtained and examined by the clinician.
- The surgeon or surgeons who care for this child can perform the appropriate orthopaedic procedures.
- The surgery, when indicated, will be performed in a timely fashion to allow ideal treatment of the fracture with special consideration given to neurovascular status, soft tissue swelling, and family situation.
- The surgeon will perform the surgery in an appropriate location. Some supracondylar humerus fractures patients may require in-hospital monitoring.
- The facility has proper implants, ancillary equipment available, and capable support personnel.
- If a patient has an open fracture, antibiotic administration and appropriate wound care are performed in a timely fashion.
- The patient can be splinted in a position of comfort and monitored adequately while awaiting operating room (OR) availability.
- The fracture occurs in a patient with open physes and is a pediatric pattern that does not require open reduction and dual plating construct (e.g. an adult pattern intercondylar distal humerus fracture).
- Particular care will be taken in children before distal humeral epiphyseal ossification (e.g. newborns, infants, and toddlers) to assess for the possibility of transphyseal or low supracondylar humerus fracture (arthrogram, MRI, etc.).
- Those patients, especially under the age of two, with fracture severity inconsistent with the described mechanism should be assessed for the possibility that this fracture resulted from non-accidental injury.
- Type III fractures and those with significant pain or swelling will be monitored in-hospital by a qualified clinician for changes in neurologic, vascular or pain status until access to the OR is available.
- The facility has the ability to evaluate and treat compartment syndrome emergently. Patient is NPO ready for anesthesia; however, NPO status should not delay patient’s surgery if the limb is in jeopardy.
- Direct manipulation at fracture site through an incision or preexisting wound is considered open reduction.
- The open soft tissue envelope refers to the soft tissue associated with the supracondylar humerus fracture and not other associated injuries.
- For closed fractures, open reduction assumes closed measures were tried, and failed.
- For new onset nerve deficit after fracture treatment, the surgeon will reassess the fracture reduction and fixation for possible nerve injury.
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