Abstract

Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present.

Highlights

  • Supracondylar humerus fracture (ScHF) represents a common bone injury in children, accounting for 60% of elbow fractures in the pediatric population [1]

  • In pediatric patients, the incidence of neurovascular complications was related to the severity of ScHF displacement as rated by the modified Gartland classification [2]

  • We found a higher prevalence of Gartland type I fractures in younger children and a higher incidence of neurovascular complications in older children

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Summary

Introduction

Supracondylar humerus fracture (ScHF) represents a common bone injury in children, accounting for 60% of elbow fractures in the pediatric population [1]. ScHF mainly affects children below the age of seven years [2]. After the age of seven years, ScHF represents the second most frequent fracture [3]. With a male-to-female ratio of 3:2 [4]. Extension-type ScHF caused by falling onto an extended elbow account for 97% to. Left or non-dominant limbs are most often affected [4]. Fractures are typically classified according to Gartland [7]. I.e., type I (non-displaced), type II (displaced, but with the intact posterior cortex), type III (completely displaced, with either posteromedial or posterolateral displacement), and type IV (displaced with multidirectional instability due to circumferential periosteal disruption) [8]

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