Supracondylar Fractures Of The Humerus Research Articles

Simultaneous Ipsilateral Pediatric Fractures of the Elbow and Forearm Attending a Tertiary Care Hospital

Introduction: Ipsilateral supracondylar humerus and forearm fractures in the pediatric population are an uncommon injury associated with high-energy trauma. The incidence varies between 3% and 13%. Our aim was to conduct a descriptive analysis on seventeen cases of children with floating elbow injuries who attended our institution and to review the literature relating to this topic.
 
 Methods: Between April 2013 to March 2016, data were obtained through the medical records. Children who had completely displaced supracondylar fractures of the humerus associated with ipsilateral forearm fracture were reviewed. All patients underwent operative reduction and percutaneous K-wire stabilization. At mean follow up of 12.9 months, all patients were assessed clinically and radiologically. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications.
 
 Results: Seventeen pediatric "floating elbow" cases that had operative management were identified. Twelve (70.5%%) were male and five (29.4%) female. The mean age was 9.5 (SD=2.1) years, ranging from six to 14 years. The left side was predominantly affected (70.5%). The commonest injury mechanism was fall from a height (76.47%). All the supracondylar fractures were Gartland type III. Majority of forearm fractures (76.4%) were at distal meta diaphyseal region. Distal radius physeal fractures were diagnosed in three patients. Open fractures occurred in three cases (17.6%). All supracondylar fractures were reduced and fixed using K-wires. There was one radial nerve, and three median nerve injury. Five patients had pin tract related complications. Fifteen (88.2%) patients had good to excellent, two had fair in terms of modified Flynn criteria in last month follow up. All patients went on to radiographic union without secondary procedures.
 
 Conclusions: This, uncommon injury in most cases, results from high-energy trauma. Early surgical treatment for both fractures is required in the form simultaneous closed reduction of the displaced forearm fracture followed by supracondylar fixation with K-wires. This provides not only stable fixation but also allows close observation for early sign and symptom of development of compartment syndrome.

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV) has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In situations where the brachial artery is compromised and needs repair with a bypass, the basilic vein should be considered as a conduit for its greater accessibility and long-term patency.

Role of Closed Reduction & Internal Fixation in Supracondylar Fractures of the Humerus

Background: Displaced supracondylar fractures have a high rate of displacement and if not reduced and stabilized in optimal position may lead to serious residual deformity. No general agreement on the treatment is evident with controversy prevailing regarding the ideal timing of surgery, method of maintenance of reduction and configuration of the pin fixation. Materials And Methods: Twenty Four males and Eight females with ages ranging from 3-12 years who required closed reduction and internal fixation using percutaneous Kirschner wire for fresh displaced supracondylar fractures of humerus between March 2012 -Dce 2015 were selected. The Kirschner wires were passed percutaneously under C-Arm control from the lateral epicondyle in varying geometry or configuration to achieve fracture stability. Each patient was followed up for at least one years and results were graded using the Flynn’s criteria. They were graded as excellent in 28 (87.50%) cases, good in 03(09.38%) cases and only 01 (03.12%) case had a poor result, there were no fair results at the end of final follow up. Conclusion: Treatment of the supracondylar humeral fracture in children by closed reduction and internal fixation is a safe approach with predictable good clinical and radiographical results. Key-words: Anatomical reduction, Percutaneous Fixation, Baumann’s angle, Humerus supracondylar fracture and closed reduction. Introduction Supracondylar fracture of the humerus is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers 1 . Supracondylar fractures of the humerus in children are difficult to treat. Closed reduction is both difficult to achieve and maintain, because of the thinness of bone at the distal third between the coronoid and olecranon, where most supracondylar fractures tend to occur. Various methods have been described for the reduction of the fracture, such as reduction of the fracture by manipulation in flexion 2 , milking maneuver to disengage the proximal fragment from the soft www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i6.10

Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit.

We aimed to identify the pattern of nerve injury associated with paediatric supracondylar fractures of the humerus. Over a 17 year period, between 1996 and 2012, 166 children were referred to our specialist peripheral nerve injury unit. From examination of the medical records and radiographs were recorded the nature of the fracture, associated vascular and neurological injury, treatment provided and clinical course. Of the 166 patients (111 male, 55 female; mean age at time of injury was seven years (standard deviation 2.2)), 26 (15.7%) had neurological dysfunction in two or more nerves. The injury pattern in the 196 affected nerves showed that the most commonly affected nerve was the ulnar nerve (43.4%), followed by the median (36.7%) and radial (19.9%) nerves. A non-degenerative injury was seen in 27.5%, whilst 67.9% were degenerative in nature. Surgical exploration of the nerves was undertaken in 94 (56.6%) children. The mean follow-up time was 12.8 months and 156 (94%) patients had an excellent or good clinical outcome according to the grading of Birch, Bonney and Parry. Following paediatric supracondylar fractures we recommend prompt referral to a specialist unit in the presence of complete nerve palsy, a positive Tinel's sign, neuropathic pain or vascular compromise, for consideration of nerve exploration. When managed appropriately, nerve recovery and clinical outcomes for this paediatric population are extremely favourable. Cite this article: Bone Joint J 2016;98-B:851-6.

Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees

The objective of this study was to evaluate and compare the outcome of the crossed and the lateral pin configurations in the management of supracondylar humeral fractures in children in the hands of junior trainees. Prospective randomized controlled trial. Level I Trauma Center. Sixty children with supracondylar humeral fractures. The mean age was 5.1 years (1.5-9 years). The minimum follow-up period was 6 months, with no patients lost to follow up. Thirty patients were managed by crossed and 30 by the lateral method. All surgeries were performed by junior trainees in their first 3 years of training. Postoperative stability, ulnar nerve injury, range of motions, and pin tract infection. The crossed configuration was stable in all the patients, whereas the lateral method was less stable in 20% of the cases because the distal fragment rotated in 5 patients and posteriorly displaced in 1 patient. The difference was statistically significant with a P value of 0.031. Ulnar nerve neurapraxia occurred in 1 patient from the lateral group and it recovered in the fourth month, whereas no ulnar nerve injury occurred in the crossed configuration group. Two patients in the lateral group lost approximately 100 of elbow flexion. This prospective randomized controlled trial showed that the crossed pin configuration method provided more stability than the lateral pin configuration, especially, in the hands of junior trainees in their first 3 years of training, and the difference was statistically significant. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Osteosinteza „în dublu X“ tip Burnei în fracturile supracondiliene de humerus la copil

Pediatric Orthopaedics Group for Research and Study – 2012 has initiated this retrospective analysis because in Romania, but also in other countries, the therapy procedures, although in great number, do not provide practicing physicians with a clear orientation according to certain therapeutic criteria in the treatment of supracondylar fractures of the humerus. As a consequence, the number of complications and their severity have drawn attention over existing lack of knowledge in the medical or surgical act. To correct complications, valgus and varus elbow, Prof. Al. Pesamosca announced an original operation entitled „Personal method in correction of varus post-traumatic elbow“ in Bacau County Meeting of 24 June 1978. This operation was later popularized by Gh. Burnei & al. with surgical interventions in patients with varus or valgus post-traumatic elbow and then presented at several congresses in the country and abroad. The last work that addressed this subject was presented at the 29th Annual Congress of the European Pediatric Orthopedic Society (EPOS) from 7 to 10 April 2010, Zagreb, Croatia, and is entitled „Distal humeral Z-osteotomy for posttraumatic cubitus varus or valgus“ having authored by Gh. Burnei, Ileana Georgescu, Stefan Gavriliu, Costel Vlad and Daniela Dan. As members of this group, based on studies we made, we want to popularize a new type of osteosynthesis, which ensures a snug fit, avoids complications, and allows rapid recovery after surgery. The best approach to this kind of fractures is orthopedic and must be carried out urgently, in the first 6 hours by reduction and immobilization in a cast, or by closed or open reduction with fixation using multiple methods (Judet, Boehler, Kapandji, San Antonio, San Diego, double-X Burnei). Open treatment is necessary in supracondylar irreducible, reducible and unstable fractures, in supracondylar fractures occurring within multiple accidental trauma, in fractures with vascular complications, in unreasonably delayed, fractures, in orthopaedically managed fractures which have displaced under cast, or in surgically treated fractures where fixation is damaged. We use Burnei technique for about 10 years. Here in Romania, great work has been done in this field by Al. Pesamosca, D. Vereanu, Ionel Ionescu, N. Negus, Pompiliu Parota, T. Zamfir, Gh. Burnei, I. Hutanu, etc. Abroad, important papers on the treatment of supracondylar fractures of the humerus have been published by L. Böhler, A. Kapandji, K. Wilkins, D. Skaggs, E. Edomnds, E. Swanson, etc. Between October 2001 and October 2011 in „Alexandru Pesamosca“ Surgery Clinic, 56 cases have been resolved with the help of Burnei’s „double-x“ osteosynthesis. These patients were operated using Kocher type unique approach, the intervention beeing primarily aimed at providing osteosynthesis that is not followed by immobilization in a cast and also enabling mobilization 24 hours after surgery. Wires placed in „double-X“ should not sit olecranon fossa. Immobilization must be anatomical and olecranon fossa must be free. After surgical intervention, check elbow flexion and extension which should be normal, without providing crackles or limitations. This intervention was done in patients: having secondary displacement in plaster after 10 days of immobilization; with other types of damaged osteosynthesis; with polytrauma with supracondylar fracture; who neglected or unjustifiedly delayed fractures that were not orthopaedically reduced in emergency and had swelling and blistering. Using Burnei’s „double-X“ osteosynthesis in supracondylar humerus fractures, does not require cast immobilization. In oblique trajectory fractures, the stability of the fracture by reduction, with or without wiring, is ensured more difficultly and often followed by joint stiffness and/or ulnar nerve paresis. Burnei’s „double-X“ osteosynthesis provides stability to such fractures and avoids complications. Mobilization of the elbow may begin immediately after surgery. The process provides comfort to the patient and doctor and if multiple injuries require repeated exams, preferred positions or care of extensive lesions of the skin.

Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls; their mean age was 7.5 years; their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.

Fracture Supracondylar Humerus: A Review.

Fracture supracondylar humerus is one of the most common fractures encountered in pediatric age group at all levels (both rural and urban). Thus it needs a special review in its management protocol as per the changing trend. Modified Gartland classification is the most accepted classification and has its importance in decision making regarding management and prognosis. Neurovascular complications are mostly associated with Type III A, III B and Type IV variety and they most of the time need surgical intervention for stabilization, exploration of brachial artery, sometimes median nerve exploration and reduction of fracture. Cubitus varus is the most common associated deformity associated with this fracture (especially in Type III A). The aim of the review was to develop an insight for the understanding of variations in presentation and management of supracondylar fracture of the humerus (both simplicity and complexity) and the flowing trend in addition to the recent advances to deal with this particular pediatric orthopaedic entity which often presents as an emergency.

Comparative study between two patterns of percutaneous K-wire fixation of supracondylar fracture of the humerus in children

Comparative study between two patterns of percutaneous K-wire fixation of supracondylar fracture of the humerus in children

Surgical Treatment of Supracondylar Fractures of the Humerus in Children

Surgical Treatment of Supracondylar Fractures of the Humerus in Children

Pediatric Supracondylar Fracture of the Humerus with Entrapment of the Median Nerve between the Bony Fragments: Report of Two Cases

Pediatric Supracondylar Fracture of the Humerus with Entrapment of the Median Nerve between the Bony Fragments: Report of Two Cases

Minimally Invasive-Closed Reduction and Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children

Introductions: Although Closed Reduction and Percutaneous Pinning is the gold standard of treatment for Supracondylar fractures (SC) in children, reduction is not always easy. Minimally Invasive, Closed Reduction and Percutaneous Pinning (MI-CRPP) reduces the soft tissue trauma and provides easy reduction. We have reviewed the success rate of minimally invasive reduction technique and its outcome.Methods: We reviewed the charts of 155 children (97 male, 58 female) age ranging from 2 to 14 years with SC fractures of the humerus who were operated with minimally invasive closed reduction and precutaneous pinning from November 2008 to June 2014 at Patan Hospital and Om Hospital. They were followed up for a mean of eight (4 to 24) weeks. The K-wires were removed at 4 to 6 (average 4.28) weeks.Results: Male children were affected more than female with the ratio being 97 to 58. Right side was affected more than left (ratio 89 to 66). Post-operatively, there were six (3.87%) ulnar nerve injury and eight (5.16%) patients came with superficial pin tract infection. One hundred and thirteen (72.9%) had excellent, 35 (22.58%) good, five (3.23%) fair and two (1.3%) poor results at the eight week follow-up which was improved to 144 (92.9%) excellent, seven (4.5%) good, three (1.9%) fair and one (0.65%) poor results at the 14 week follow-up.Conclusions: Closed reduction of supracondylar fractures of the humerus in children with minimally invasive technique prior to K-wire fixation is a relatively simple, safe and effective method of achieving satisfactory reduction and good functional outcome.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children. MethodsWe prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n=5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. ResultsLateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn’s criteria, 90.4% patients showed satisfactory results. ConclusionLateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children.

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.

Reduction and stabilization of acute, displaced supracondylar fractures of distal humerus in children using the Sauvé-Kapandji technique

Paediatric displaced supracondylar fractures of the humerus are unstable injuries and if not reduced and stabilized in optimal position can lead to serious residual deformity. We report the results of reduction and stabilization of displaced supracondylar fractures using the Sauve-Kapandji technique. Eight males and five females, age ranging from 2 to 8 years with acute extension-type displaced supracondylar fractures of distal humerus, treated between January 2009 and March 2011 in our department were included in the study. The fracture was reduced using the Sauve-Kapandji technique. The first wire was passed posteriorly through the fracture site under fluoroscopic control and was used to reduce the fracture. The fracture was then stabilized with two or three cross Kirschner wires, passed percutaneously under X-ray control. Each patient was followed up for 2 months to 1 year. There was clinical and radiological evidence of healing at 6 weeks postoperatively in all cases. One patient had neurapraxia of anterior interosseous nerve and made full recovery. All patients except for one had full range of movements at the elbow joint at 6 weeks. One patient had loss of 15° extension but gained full range of movements at 1-year review. All patients had normal carrying angle, and no gunstock deformity was noted. All patients had normal function at the elbow joint at the final follow-up visit. The management of acute, displaced supracondylar fractures of the humerus in children using the Sauve-Kapandji technique has shown excellent results in terms of healing of the fracture and functional outcome. We recommend this technique as an alternative in cases of encountering difficulties in fracture reduction prior to proceed with open reduction.

Reproducibility of the AO/ASIF and Gartland classifications for supracondylar fractures of the humerus in children

ObjectiveTo evaluate the reproducibility of the radiographic classifications of Gartland and the Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) for supracondylar fractures of the humerus in children. MethodsOn two occasions, 50 radiographs in anteroposterior and lateral views were evaluated by three pediatric orthopedists in accordance with the Gartland and AO/ASIF pediatric classifications. Their responses were subjected to statistical analysis consisting of calculation of the κ coefficient to assess the intra- and interobserver concordance, in both classifications. ResultsThe strength of the intraobserver concordance was high or near perfect for the three examiners in the two classification systems. The strength of the interobserver concordance was high in the two systems, with κ coefficients of 0.756 for the Gartland classification and 0.766 for the AO/ASIF classification. ConclusionThe Gartland and AO/ASIF classification systems showed similar reproducibility and performance. High strength of concordance was seen in the intra- and interobserver analyses.

Hypoplasie de la joue latérale de la trochlée à distance d’une fracture supracondylienne de l’humérus non déplacée chez l’enfant : à propos d’un cas

We report the case of a 13-year-old boy presenting with stiffness and pain in the elbow, which had appeared a few years before consultation. He reported a history of a closed, nondisplaced supracondylar fracture of the humerus 7years before. Progression was good after orthopedic treatment. X-rays and CT showed a distinctive deformation, called a fishtail deformity, associated with severe arthritic injuries. We recall here that supracondylar fractures of the humerus are common in children and that early reduction decreases the complication rate. However, this case shows that fishtail deformity is a late and serious complication, which may occur after a nondisplaced supracondylar fracture of the humerus, with no severity factors and with good early progression.

Reprodutibilidade das classificações AO/ASIF e Gartland para fraturas supracondilianas de úmero em crianças

ObjectiveTo evaluate the reproducibility of the radiographic classifications of Gartland and the Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) for supracondylar fractures of the humerus in children. MethodsOn two occasions, 50 radiographs in anteroposterior and lateral views were evaluated by three pediatric orthopedists in accordance with the Gartland and AO/ASIF pediatric classifications. Their responses were subjected to statistical analysis consisting of calculation of the κ coefficient to assess the intra and interobserver concordance, in both classifications. ResultsThe strength of the intraobserver concordance was high or near perfect for the three examiners in the two classification systems. The strength of the interobserver concordance was high in the two systems, with κ coefficients of 0.756 for the Gartland classification and 0.766 for the AO/ASIF classification. ConclusionThe Gartland and AO/ASIF classification systems showed similar reproducibility and performance. High strength of concordance was seen in the intra and interobserver analyses.

Results of displaced supracondylar humerus fractures treated with open reduction and internal fixation after a mean 22.4 years of follow-up

The aim of this study was to evaluate the long-term functional and cosmetic results as well as the sagittal and coronal plane remodeling of displaced supracondylar humerus fractures treated with open reduction and internal fixation. In total, 49 patients (11 boys and 38 girls) with Gartland type III supracondylar humerus fractures treated with open reduction and cross-pin fixation were retrospectively evaluated. The mean follow-up time was 22.4 years (range, 10.6-37.5 years). The Flynn criteria were used to assess the cosmetic and functional outcomes. Baumann's angle, the lateral rotational percentage, the humerus-elbow-wrist angle, and the humeral condylar angle were obtained from follow-up radiographs. The flexion and extension deficits compared with the uninjured side were measured at the last follow-up. According to the Flynn criteria, the cosmetic outcomes were satisfactory in 93.9% of the patients, and the functional outcomes were satisfactory in 83.7% of the patients. The average flexion deficit was 5° ± 8°, and the average extension deficit was 4° ± 5°. At the final follow-up, the mean difference in the humerus-elbow-wrist angle and the humeral condylar angle between the injured and uninjured sides was -4° ± 7° and 0° ± 3°. We identified the remodeling in the sagittal plane in supracondylar humerus fractures that had been united in flexion. Satisfactory functional and cosmetic results were obtained with the open reduction and internal fixation of displaced supracondylar fractures of the humerus, and no degenerative changes were observed at the long-term follow-up.

Management of displaced supracondylar fracture of the humerus in children

Background: There have been controversies regarding the ideal method of treatment of displaced supracondylar fractures of the humerus in children. Aims: The aim was to treat displaced supracondylar fractures of the humerus in children by conservative method and if results are not acceptable then by operative method and evolve a management protocol which will provide minimum complications with available facilities. Materials and Methods: This prospective study was conducted in a tertiary care hospital in a time span of 1-year. Ninety patients with Gartland's Type II and Type III fractures were initially subjected to closed manipulative reduction, of which acceptable reduction could be achieved only in 27 patients. Sixty-three patients who had unacceptable results were subjected to operative treatment. The final results of the treatment were assessed using the criteria of Flynn et al. Results: Among the Gartland's Type II fracture patients, acceptable reduction was achieved in 9 patients. Among Type III fracture, acceptable reduction was achieved in 18 patients (25%). The conservative treatment yielded excellent results for 9 patient and good for 9 patients. Of the 63 patients subjected to operative treatment, 15 patients had excellent result (23.81%), 24 good (38. 10%), 15 fair (23.81%), and 9 poor (14.29%). Satisfactory result was achieved in 39 patients (61.90%). Conclusion: Closed reduction in case of supracondylar displaced fracture of the humerus in children still remains an option in a developing country. It may be, followed by closed operating techniques when results are not acceptable as this delay does not affect functional outcome.