Abstract
Context (Background): Supracondylar humerus fractures are one of the commonest upper limb fractures in children. Closed reduction and fixation with K wires is the most common method of treating these fractures. Stability of fixation is very important so as to prevent loss of reduction, which leads to deformity at elbow joint. Many factors contribute to the stability of fixation. Thus, considering all these factors at the fixation helps prevent loss of reduction. Aim: This prospective study was aimed at studying the functional outcome of management of supracondylar humerus fracture in the pediatric population when the management is planned as per the fracture patterns described by Bahk. Setting and design: This is a single center prospective study conducted between July 2018 and June 2019.This study was done in a medical college and general hospital, which is a tertiary care center. Method: 100 cases of supracondylar humerus fractures in children were analyzed prospectively. Various parameters were documented to assess the functional outcome. Results: There was mean loss of motion at the elbow of 41˚ in conservatively managed cases and 43˚ in operated cases at 4th week follow up. Gradually it improved to full range.Loss of carrying angle was seen in only 8% of cases and the degree was very less. As per Flynn’s criteria, 94% of cases had excellent cosmetic outcome and 6% of cases had good cosmetic outcome. Anterior humeral line passed through middle one third of capitellum in 91% of cases. Loss of Baumann’s angle was seen in only 9% of cases. As per Skaggs et al criteria for loss of reduction, only 1 case had a moderate loss of reduction and 8 cases had mild displacement. Conclusion: Deciding about pin configuration for fixation should be done as per the fracture pattern and fracture comminution. This reduces the chance of loss of reduction and improves functional outcome. In fractures that are amenable for lateral only fixation, 3 laterals pins should be preferred. Keywords: Supracondylar humerus fracture; Bahk’s fracture pattern; functional outcome; Flynn’s criteria; Skaggs criteria
Highlights
Supracondylar humerus fractures are one of the commonest upper limb fractures in children, which accounts for 18% of all pediatric fractures and up to 60% of pediatric elbow fractures. [1] About 85% of these fractures are seen in children of age 5-8 years
We have considered Bahk’s fracture pattern and fracture comminution to decide how to pin the injury
One patient presented with absent radial pulse, which recovered after reduction and fixation
Summary
Supracondylar humerus fractures are one of the commonest upper limb fractures in children, which accounts for 18% of all pediatric fractures and up to 60% of pediatric elbow fractures. [1] About 85% of these fractures are seen in children of age 5-8 years. To decide on how to pin these injuries, the fracture patterns are to be considered. [7] Bahk et al has classified supracondylar fractures of humerus based on orientation of the fracture line in sagittal as well as coronal plane [4]. In coronal plane he has described 4 fracture patterns. Deciding how to pin the fracture by seeing the pattern would help to increase the fracture stability following fixation. We have considered Bahk’s fracture pattern and fracture comminution to decide how to pin the injury. We have analyzed various factors like Bahk’s fracture patterns, number of pins, pin configuration, fracture stability following fixation and loss of fixation postoperatively
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