Management of Supracondylar Fractures of the Humerus in Children
Background : Supracondylar fractures are the most common elbow fractures in children and account for 3 to 7% of all fractures.. Objectives : The purpose of the study was to review and analyze the treatment pattern of supracondylar humerus fractures in children. Methods : 112 children with supracondylar fractures were treated in the orthopaedic department of Rustaq Hospital, Oman between February 1998 and September 2003. 110 fractures were extension type while two were flexion type injuries and were not included in our study. Fractures were classified according to Gartland classification. Results : Type I fractures were seen in 25 patients, Type II fractures in 50 patients and 35 patients had type III fractures. Indications for treatment were determined according to fracture type. Patients were divided into two groups Group A patients (Type I) were treated by external immobolisation with posterior cast slab application. Group B (Type II / III) patients underwent closed reduction with percutaneous Kirschner wire fixation. Two patients in group B where closed reduction was unsatisfactory underwent open reduction and internal fixation. In group A patients, 4 (16%) had neurapraxias whereas in group B patients transient neurologic complications were seen in 20% cases and iatrogenic nerve injury in 1.1% cases. All neurologic complications in group A and B resolved over a period of 4 months. Vascular compromise was noted in three cases in group B patients. Two cases recovered and one patient had Volkmann's Ischemia with subsequent sequelae. None of the patients in group A had any vascular injuries. 90% of operated patients had good functional outcome. Conclusion : From our study we concluded that all manipulations should be performed immediately in order to avoid severe swelling, neurological or vascular complications. Indication for open reduction and internal fixation includes open fractures, unsatisfactory closed reduction and fractures associated with vascular injury.
Keywords: Humerus, Supracondylar Fracture, Vascular Compromise
Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 58-60