Limited open reduction with internal fixation versus closed reduction with external fixation in the treatment of irreducible supracondylar humerus fractures in children: an outcome comparison

Abstract

Objective To compare the clinical results of treating irreducible supracondylar humerus fractures (Gartland type Ⅲ) in children with limited open reduction and internal fixation versus closed reduction with external fixator. Methods The clinical data of 34 pediatric patients who had been treated for supracondylar humerus fractures (Gartland type Ⅲ) from January 2012 to January 2014 were available for retrospective analysis. Eighteen patients were treated with limited open reduction via a limited medial or lateral incision followed by percutaneous Kirschner wire fixation (internal fixation group). The other 16 patients were treated with closed reduction followed by application of an external fixator (external fixation group). Surgery time, intraoperative radiography frequency, fracture healing time, the change of Baumann angle at 3 days and 2 months postoperatively, and elbow function were compared between the two groups. Results All the patients received a mean follow-up of 16.5 months (range, 12 to 24 months). Compared with the external fixation group, the internal fixation group needed significantly shorter average surgery time (49.1±6.6) minutes versus (72.3±12.6) minutes and significantly lower average intraoperative radiography frequency (3.6±0.9) times versus (10.1±2.0) times (P<0.05). All the fractures achieved clinical healing at 4 weeks postoperatively and bone union at 2 months postoperatively. The change of Baumann angle between 3 days and 2 months postoperatively was (2.4±1.3)° on average in the internal fixation group and (6.1±2.1)° on average in the external fixation group, with a significant difference (P<0.0001). Evaluation of elbow function using the Flynn elbow scoring system at 3 months postoperatively revealed a 27.8% (5/18) good to excellent rate in the internal fixation group and 25.0% (4/16) in the external fixation group. The good to excellent rate increased to 99.4% (17/18) in the internal fixation group and to 81.3% (13/16) in the external fixation group at 12 months postoperatively. There were no complications such as delayed union, compartment syndrome or iatrogenic lesions to vessels and nerves. Conclusion In the treatment of pediatric irreducible supracondylar humeral fractures (Gartland type Ⅲ), both limited open reduction with internal fixation and closed reduction with external fixation can lead to fracture healing within similar time. Limited open reduction with internal fixation can achieve more satisfactory reduction and more stable fixation, and can result in shorter operative time, lower intraoperative radiography frequency and better elbow function. Key words: Child; Fracture fixation, internal; External fixators; Supracondylar humerus fracture