A.D.IsaA.FureyC.StoneFunctional outcome of supracondylar elbow fractures in children: A 3–5 year follow-upCan J Surg572014241246

Abstract

The authors retrospectively reviewed the cases of children with a supracondylar elbow fracture (SCEF) who presented to their tertiary care pediatric emergency department between January 2005 and December 2009. There were 94 children in this study, and their charts were reviewed for age, sex, classification of fracture severity, weight, comorbidities, operative or nonoperative treatment, postoperative physiotherapy and associated nerve injury. A Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered in 2012 by the parents of the patients with the child present; if they were old enough, the patients completed the questionnaire themselves under a parent's supervision. Long-term functional outcome using standardized tools has not been well documented in the literature. However, for clinimetric purposes, the DASH questionnaire received the best ratings. Three fellowship-trained pediatric orthopedic surgeons independently reviewed the radiographs and grouped the patients according to the Gartland classification which is widely used in the literature: Type 1 fractures are nondisplaced; type 2 are displaced with a variable amount of angulation; type 3 are completely displaced. The pediatric orthopedic surgeons in this study treated the patients either operatively or nonoperatively based on the degree of angulation and displacement. Type 1 were treated nonoperatively; type 2 were treated either way depending on the amount of angulation and displacement; all type 3 were treated operatively. Patients who were operated on underwent closed reduction and percutaneous pinning under fluoroscopy. If reduction could not be obtained with closed reduction, open reduction and percutaneous pinning were performed. At the three month follow-up by the same pediatric orthopedic surgeons, patients were seen to assess the need for physiotherapy. Of the 94 patients included in the study group, 57% were male, 56% had a type 1 fracture, 28% type 2, 16% type 3, and the left elbow was the side more commonly injured. The mean age of patients with type 1 was 70 months, type 2 was 74 months, and type 3 was months. There was no statistical difference, even with sports, or performing arts functions, in the functional outcome, regardless of sex, age at injury, type of fracture, weight, right or left extremity or surgery. These types of fractures, regardless of several parameters, tend to have good functional outcomes provided that satisfactory reduction is maintained. There was no significant difference between patients treated operatively and nonoperatively. The degree of displacement should guide management, as SCEF tends to do well if adequate reduction is obtained and maintained in an uncomplicated course.