BRACHIALIS MUSCLE ENTRAPMENT IN DISPLACED SUPRACONDYLAR HUMERUS FRACTURES - A TECHNIQUE OF CLOSED REDUCTION AND REPORT OF INITIAL RESULTS

A retrospective review was conducted of 152 extension-type supracondyl ar humerus fractures in 151 children. Ninety-two (61%) of 152 of these fractures were displaced (Gartland type III). Initial irreducibility was present in 20 of the 92 displaced fractures. Brachialis muscle int erposition was diagnosed by physical examination or intraoperative fin dings in 18 (90%) of the 20 initially irreducible fractures. Sixteen o f the fractures with brachialis muscle interposition underwent an atte mpt at freeing the impaled proximal fragment by the described ''milkin g maneuver.'' The maneuver was successful in 15 of the 16 patients and was followed by closed reduction and percutaneous pinning. Three of t he remaining four cases required open reduction and pinning, We identi fy the incidence of initial irreducibility in displaced supracondylar humerus fractures, describe clinical findings suggestive of brachialis entrapment, and demonstrate the milking maneuver to be a valuable tec hnique in the treatment of displaced supracondylar fractures with brac hialis interposition.