SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN

Nikola Bojović,Miroslav Stojanović,Dragoljub Živanović,Nikola Vacić,Goran Janković,Nina Đorđević,Zoran Marjanović

doi:10.5633/amm.2012.0301

Abstract

Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%). They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand. We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification). At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of „К“ wires. None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3–4 weeks). Bauman’s angle, carrying angle and functional factor were measured postoperatively. Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments). Acta Medica Medianae 2012;51(3):5-12.

Highlights

Humeral supracondylar fractures (Figure 1) are the second most common fractures seen in children and young teenagers (16.6%) [1]
Possible modalities for treating these kinds of fractures are: skeletal traction, closed reposition followed by cast immobilization, percutaneous pinning following open/closed reposition, and open reposition followed by inner fixation (1215)
Four patients (3 open and 1 closed reposition) had a superficial infection around the "K" wires, which was resolved by prescribing the oral antibiotics

Summary

Introduction

Humeral supracondylar fractures (Figure 1) are the second most common fractures seen in children and young teenagers (16.6%) [1]. They account for 60-70% of all the elbow fractures [2, 3]. In 2-5% of cases, an associated fracture on the same side occurs - radial, ulnar or both [6]. By evaluating 4.520 cases of supracondylar fractures of humerus found in 31 series in the literature, Wilkins established the classification regarding the mechanism of trauma and displacement course: 90-98% of all fractures belong to the so-called extension type occurring by falling on the extended arm, and less than 5%.

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