insertion should be done with care to prevent nerve injuries around elbow region. percutaneous pinning should be done when close manipulation fails to achieve the reduction, unstable fracture after closed reduction, neurological deficits occurs during or after the manipulation of fracture, and surgical exploration is required to determine the integrity of the blood vessels and nerves. in open fractures, surgical wound debridement should be performed to prevent any infection into the elbow joint. all type ii and iii fractures requiring elbow flexion of more than 90° to maintain the reduction needs to be fixed by percutaneous pinning. all type iv fractures of supracondylar humerus are unstable; therefore, requires percutaneous pinning. besides, any polytrauma with multiple fractures of the same side requiring surgical intervention is another indication for percutaneous pinning. follow up for routine displaced supracondylar fractures requiring percutaneous pinning, radiographic evaluation and clinical assessment can be delayed until the pin removal. pins are only removed when there is no tenderness over the elbow region at 3 to 4 weeks. after pin removal, mobilisation of the elbow can begin. neurovascular complications absence of radial pulse is reported in 6 to 20% of the supracondylar fracture cases. this is because brachial artery is frequently injured in gartland type ii and type iii fractures, especially when the distal fragment is displaced postero-laterally (proximal fragment displaced antero-medially). open/closed reduction with percutaneous pinning would the first line of management. however, if there is no improvement of pulse after the reduction, surgical exploration of brachial artery and nerves is indicated, especially when there is persistent pain at the fracture site (indicating limb ischaemia), neurological deficits (paresthesia, tingling, numbness), and additional signs of poor perfusion (prolonged capillary refilling time, and bluish discolouration of the fingers). meanwhile, for pink, pulseless hand (absent radial pulse but with good perfusion at extremities) after successful reduction and percutaneous pinning, the patient could still be observed until additional signs of ischaemia develops which warrants a surgical exploration. isolated neurological deficits occurred in 10 to 20% of the cases and can reach as high as 49% in type iii gartland fractures. neurapraxia (temporary neurological deficits due to blockage of nerve conduction) is the most common cause of the neurological deficits in supracondylar fractures. such neurological deficits would resolve in two or three months. however, if the neurology is not resolved for this time frame, surgical exploration is indicated. epidemiology supracondylar humerus fractures is commonly found in children between 5 and 7 years (90% of the cases), after the clavicle and forearm fractures. it is more often occurs in males, accounting of 16% of all pediatric fractures and 60% of all paediatric elbow fractures. the mechanism of injury is most commonly due to fall on an outstretch hand. extension type of injury (70% of all elbow fractures) is more common than the flexion type of injury (1% to 11% of all elbow injuries). injury often occurs on the non-dominant part of the limb. flexion type of injury is more commonly found in older children. open fractures can occur for up to 30% of the cases.