Abstract: Objective There is an uncommon subset of supracondylar humeral fractures in children that are so unstable they can displace into both flexion and extension. The purposes of this study were to describe this subset of supracondylar fractures and to report a technique of opened reduction and percutaneous pinning for their treatment.Methods In a review of 8 severely displaced displaced supracondylar humeral fractures in children treated operatively at our institution, we identified eight that were completely unstable with documented displacement into both flexion and extension as seen on fluoroscopic examination with the patient under anesthesia. We used a technique for opened reduction and fixation of these fractures, and then we assessed fracture-healing and complications from the injury and treatment.Results All eight fractures were treated satisfactorily with opened reduction and percutaneous pinning. None of the patients had a nonunion, cubitus varus, malunion, additional surgery, or loss of motion.Conclusions In severely displaced supracondylar fractures in children, multidirectional instability results in displacement into flexion and/or extension. This fracture may be classified as type IV according to the Gartland system, Severely displaced supraacondylar f racture of the humerus still needs open reduction These fractures can be treated successfully with a technique of opened reduction and percutaneous pinning. hard intermal and external fixation ,early elbow joint functional training are the important measures 。

摘要： 目的 探讨严重移位的、屈曲及伸直位均不稳定的小儿肱骨髁上骨折Gartland Ⅳ型治疗。方法 对2008 年3月～2010年8月我院收治的8 例儿童严重的Gartland Ⅳ型肱骨髁上骨折的手术治疗疗效进行评价，分析此类型小儿肱骨髁上骨折手法复位失败的原因和切开复位克氏针固定的治疗效果。结果 8例Gartland III型肱骨髁上骨折患儿均接受切开复位及克氏针内固定术，早期进行肘关节功能锻炼，总体效果良好。随访1～3年，无一例发生骨不连，肘内翻，神经损伤。结论 Gartland III型肱骨髁上骨折切开复位仍是主要治疗手段。同时，早期进行肘关节功能锻炼，是提高本种类型骨折治疗疗效、防止肘内翻畸形发生的关键。

关键词: 肱骨, 外科治疗, 内翻畸形, Humerus, cubitus varus