A common distal humeral fracture in children is a supracondylar or unicondylar fracture. Some presentations are similar for all condylar fractures. 1. X-rays are easily misinterpreted. This is because: (1) the fracture fragment consists mainly of cartilage; (2) in the undeveloped child, the x-ray shows a smaller bone fragment than it actually is; and (3) the displacement, although it has some name, does not appear to be appropriate. (2) The strong flexor and extensor muscle groups are attached to the medial and lateral condyles, often causing rotation and displacement of the condyle due to muscle pulling. Even after closed repositioning, re-displacement can often occur due to muscle pull on the bone fragments. 3. Although the bone fragments can be brought together during surgery, there may be difficulties in the correct alignment of the fracture surface and the epiphyseal plate. 4. Internal fixation is required after repositioning because the slightest traction can cause displacement of the bone fragments after the muscle is placed in place under mild tension. 5. Internal fixation is usually done with a smooth kerfing pin, which is withdrawn after 4-6 weeks. Although fixation of the pin through the epiphyseal plate would theoretically cause growth disturbance, it is rare, so the pin can also be placed through the epiphyseal plate if necessary. Failure to diagnose and treat distal humeral fractures in children can result in serious complications: 1. Bone nonunion: Most often seen in simple condylar fractures. 2. malunion: non-union or epiphyseal growth disorders can cause changes in the carrying angle of the elbow. malunion of the supracondylar fracture can lead to inversion deformity of the elbow, and fracture of the epicondyle and resulting non-union can lead to increased carrying angle and valgus deformity of the elbow. 3. Epiphyseal growth disorders: commonly seen in Salter-Harris type 3 or 4 epiphyseal injuries, which can cause elbow inversion or elbow valgus. 4. Ischemic necrosis of the condyle: this complication is uncommon. 5. Acute vascular nerve injury: Acute nerve or vascular injury caused by elbow fracture in children is not uncommon, and if treated immediately and correctly, this injury can disappear quickly without leaving permanent complications. The most serious vascular complication of the elbow is Volkmann contracture, which can cause severe acute loss of forearm and hand function. The possibility of nerve and vascular injury should be thought of in all elbow fractures in children, especially supracondylar fractures. If the patient can bend the fingers with the metacarpophalangeal joint straight and the thumb can palm the little finger, the three major nerve trunks are not injured. Sensory deficits should also be tested. If there is circulatory disturbance, it is manifested by diminished or absent radial artery pulsation, slowed capillary filling, swelling, bruising, and sensory numbness in the hand. Neurovascular testing should be repeated after treatment, and close postoperative observation of the neurovascular condition of the hand is very important, and any changes need to be brought to attention in a timely manner.