Surgical Pinning (CRPP) for a Supracondylar (Elbow) Fracture

What this surgery is

A supracondylar fracture is a break in the upper-arm bone (humerus) just above the elbow — one of the most common elbow fractures in children. Your child had a procedure called closed reduction and percutaneous pinning (CRPP). “Closed reduction” means the surgeon lined the bones back up without a large incision. “Percutaneous pinning” means smooth metal pins (also called K-wires) were placed through the skin and across the break to hold the bone in the correct position while it heals.

After the pins are placed, the arm is protected in a cast or splint, usually with the elbow bent about 90 degrees. The pin ends are left just outside the skin (or just under the cast padding) so they can be removed easily in the office later.

Why it was done

Supracondylar fractures that are out of place (displaced) will not heal in a good position with a cast alone. Pinning holds the bones lined up so the elbow heals straight and moves normally.

The cast or splint

• Keep the cast clean and completely dry at all times.
• Do not let your child put anything inside the cast, and do not put powder or lotion inside or at the edges.
• Keep the arm raised above the level of the heart as much as possible for the first 2–3 days to control swelling.
• Do not let your child bear weight on the arm or hang from it.

Pin care

• The pins stay covered under the cast — you do not need to clean them at home.
• A small amount of clear or pink drainage at the pin sites can be normal.
• The pins are removed in the office, usually about 3–4 weeks after surgery. This is quick and most children do not need to be put back to sleep for it.

Pain control

• Most discomfort is well controlled with acetaminophen (Tylenol) and ibuprofen (Motrin) used as directed.
• Give any prescribed pain medicine exactly as directed; stronger medicines are usually only needed for the first day or two.
• Keeping the arm elevated is one of the best ways to reduce pain.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 100.4°F (38°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Foul smell or pus-like drainage coming from the cast or pin sites
• The cast becomes wet, cracked, soft, too loose, or too tight
• Something gets stuck inside the cast

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Your child will be seen in the office in about 1 week for an X-ray, and again at about 3–4 weeks to remove the pins and (usually) the cast. Most supracondylar fractures heal in about 3–4 weeks. Elbow stiffness is common at first and almost always improves on its own over the following weeks; formal physical therapy is rarely needed.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Percutaneous pinning). It is provided by pediatric orthopaedic surgeons.