Sagittal Plane Malalignment in Paediatric Supracondylar Fractures of the Distal Humerus: A Review of the Literature

Abstract

AIM: Sagittal plane malalignment in supracondylar fractures of the humerus is thought to remodel well and be of doubtful functional significance. Consequently it has been given little attention. Our aim was to review the contemporary literature for consensus about the optimal radiographic method to assess sagittal plane alignment, define acceptable limits of reduction in this plane and assess the functional consequences of the ensuing hyperextension deformity. METHODS: A search of MEDLINE(Ovid), PubMed, EMBASE, CINAHL and the Cochrane & DARE databases for “supracondylar fracture*” AND “sagittal” OR “anterior humeral line” OR “humerocapitellar angle” was conducted in October 2013. RESULTS: The search identified 42 articles. Of these, 13 papers evaluated optimal radiological parameters or patient outcomes in supracondylar fractures with reference to sagittal plane deformity. CONCLUSIONS: Inadequate reduction of supracondylar fractures in the sagittal plane results in loss of elbow flexion, although it may not be significantly disabling. The humerocapitellar angle has better reliability and prognostic value than any other radiographic measurement, but should not be used in isolation. In children under the age of 6 a humerocapitellar angle of 42 degrees +/- 18 degrees is acceptable. In older children who have limited remodelling potential, variability of +/- 6 degrees is acceptable.