Changing the Management from Olecranon Screw Traction to Percutaneous Wiring for Displaced Supracondylar Fractures of the Humerus in Children. A Justified Decision?

Abstract

In this institution, the management of displaced (Gartland III) supracondylar fractures in children was changed from overhead olecranon screw traction to manipulation and percutaneous wiring in 1996. The purpose of this study was to compare the two methods of treatment and observe whether the decision to change management was justified. A retrospective study of two cohorts; 151 patients between 1986 and 1996 treated with olecranon screw traction and 92 patients between 1996 and 2002 treated with percutaneous wiring. Both sets of patients were followed up clinically and radiologically until the child could demonstrate a satisfactory range of movement and the fracture had united. There were no differences in the clinical outcomes between the two groups. The main difference between the groups was in length of stay, which was a median of 1 day in the wired group and 14 days in the traction group. Outcomes achieved from percutaneous wiring of displaced supracondylar fractures are similar to those from olecranon screw traction. The advantage of percutaneous wiring to both patient and provider is the reduced hospital stay. The decision to change management therefore appears to be justified. However, percutaneous wiring is generally a technically more demanding procedure and olecranon screw traction should remain a possible treatment option for the management of this injury.