Limited open reduction versus closed reduction in treatment of supracondylar humerus fractures in children

Abstract

Objective To compare the clinical effects of limited open reduction versus closed reduction in treatment of supracondylar humerus fractures (Gartland type Ⅲ) in children.Methods The clinical data of 98 children who had been treated for supracondylar humerus fractures (Gartland type Ⅲ) in our department from January 2008 to December 2010 were available for the present retrospective analysis.Eighty-seven patients were treated with open reduction via a limited medial or lateral incision followed by internal fixation while the other 20 with closed reduction followed by internal fixation.In the limited open reduction group,there were 53 boys and 25 girls,with a mean age of 76.4 months; in the closed reduction group,there were 15 boys and 5 girls,with a mean age of 70.7 months.The 2 groups were compared in terms of operative time,intraoperative radiography frequency,fracture healing,Flynn elbow scoring at 3 and 12 months postoperation.Results Compared with the closed reduction group,the limited open reduction group needed significantly shorter average operative time (52.2-7.0 minutes versus 72.8 ± 13.7 minutes) and significantly lower average intraoperative radiography frequency (3.3 ± 1.0 times versus 9.9 ± 1.9times) (P ＜ 0.05).The 98 patients received a mean follow-up of 16.3 months (from 12 to 24 months).All the fractures achieved clinical healing at 4 weeks post-operation and bony union at 2 months post-operation.By the Flynn elbow scoring at 3 months postoperation,the good to excellent rate was 24.4 ％ (19/78) in the limited open reduction group and 30.0％ (6/20) in the closed reduction group,with no significant difference (P ＞ 0.05).However,the good to excellent rate at 12 months post-operation was 100％ (78/78) in the limited open reduction group and 95.0％ (19/20) in the closed reduction group,with a significant difference (P ＜ 0.05).No delayed union,compartment syndrome or iatrogenic lesions to vessels and nerves occurred and no supracondylar osteotomy was needed in either group.Conclusions In treatment of supracondylar humerus fractures (Gartland type Ⅲ) in children,both limited open reduction and closed reduction can lead to fracture healing in similar time and similar functional recovery of the elbow.It is essential to perform limited open reduction when closed reduction fails.Limited open reduction can result in shorter operative time,lower intraoperative radiography frequency and better functional outcomes. Key words: Elbow joint; Humeral fractures; Fracture fixation, internal; Child