Supracondylar fracture of humerus in children; presentation and outcome in a tertiary centre of Sri Lanka

Abstract

Introduction: Supracondylar fracture is an important long bone fracture in children. It is of special concern due to the neurovascular injuries and malunion associated with it. Fracture sub-types, associated injuries and grades are important in decision making. The objectives were to assess epidemiology and closed manipulation impact on neurovascular outcomes. Methods: Consecutive patients were included in the study. Structured questionnaire was filled denoting demography, severity, subtypes and associated injuries. All patients underwent closed reduction and initial casting. Outcome was measured objectively to decide on need of open surgery. Results: There were 75 patients (male - 58%). Ninety two percent were extension-type while 48% and 21% were Gartland type 2 and 3, respectively. Neurological and vascular deficit was observed in 11% and 8% of patients, respectively. Major mechanisms of injury were direct fall (64%) and road traffic injuries (20%). Regression showed neurovascular deficit, need of open reduction and varus deformity was significantly higher with Grade 3 fracture (P Oxford elbow score was not different between Grade 2 and Grade 3. Eighty seven percent of Grade 2 and 68% of Grade 3 fractures were successfully reduced with closed manipulation. Conclusions: Vascular and neurological deficits were seen in 11%and 8% of patients but they were transient in most cases. Closed reduction alone has achieved good results in a majority. Further analysis is planned in future to compare these data with, closed reduction and percutaneous pinning.