Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 3 2026 07 16 143 7 EN Negin Bayat Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Ramin Haj Zargarbashi Associate Professor, Department of Orthopedics and Trauma Surgery, Children's Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Taghi Baghdadi Professor, Department of Orthopedics, Joint Reconstruction Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Pouya Tabatabaei Irani Assistant Professor, Department of Orthopedics, Joint Reconstruction Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 12 10 2026 05 25 Background: Supracondylar humerus fractures are the most common pediatric elbow injuries. Avascular necrosis (AVN) of the distal humerus is rare and may present months to years after injury, even when minimally displaced. Case Report: Two children developed distal humeral AVN after supracondylar fractures, one treated in a cast and one with percutaneous pinning. Both later reported pain, motion loss, and deformity. Imaging confirmed AVN, with a fishtail deformity in one case and cubitus-varus deformity in the other. The first was observed with preserved function; the second underwent a lateral closing wedge extension osteotomy with good recovery. Conclusion: Distal humeral AVN can follow both nondisplaced and displaced injuries. Young patients and higher-risk patterns warrant prolonged follow-up until trochlear ossification. Early recognition and a structured surveillance plan support timely intervention and better outcomes. https://jost.tums.ac.ir/index.php/jost/article/view/752 https://jost.tums.ac.ir/index.php/jost/article/download/752/478