Compared outcomes after percutaneous pinning versus open reduction in paediatric supracondylar elbow fractures

Abstract

Supracondylar fractures of the elbow are common in children. Their treatment is controversial when displacement has occurred, although percutaneous pinning is usually advocated. In paediatric extension-type supracondylar fractures of the elbow, percutaneous pinning and crossed K-wire fixation after open reduction via the medial approach produce similar functional outcomes and complication rates. We retrospectively reviewed the medical charts of 58 children aged 2 to 15 years who underwent surgery for extension-type supracondylar elbow fractures between 2004 and 2008. Closed reduction and percutaneous pinning was used in 33 patients with a mean age of 7 years and 11 months; open reduction with cross-wiring in 25 patients with a mean age of 7 years. Functional outcomes were assessed using Flynn's criteria. Baumann's angle was determined and postoperative complications and sequelae were recorded. Outcomes were satisfactory in 30 (90.9%) patients treated with percutaneous pinning and in 23 (92%) patients treated with open reduction and cross-wiring. Mean Baumann's angle at last follow-up was 73.9±5.74° after percutaneous pinning and 74.76±4.07° after open reduction and cross-wiring. Postoperative complications consisted of reoperation in six (10.3%) patients and iatrogenic nerve injury in two (3.4%) patients. Cubitus varus occurred in two (6.06%) patients after closed treatment and in one (4%) patient after open treatment. In each group, three (5.1%) patients had greater than 15° of motion range limitation. In children with extension-type supracondylar elbow fractures, outcomes are similar with percutaneous pinning and with open reduction via the medial approach followed by cross-wiring. Level IV, retrospective study.