DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20202529

A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

Vinay N., Manjunatha A., Anand Kumar B. S.

Abstract


Background: Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly in children more so in male child with the peak around 5-8 years. Objective of this study was to compare the outcome of 3 different modalities of treatment for supracondylar fracture of humerus.

Methods: Children with type III supracondylar fracture of humerus were categorized into group A, group B, group C based on conservative, closed reduction and percutaneous K wire fixation and open reduction and K wire fixation modalities of treatment given. All the children were followed for 6 months and the outcome of treatment was evaluated using Flynn’s criteria.

Results: 40 children were treated with 3 different modalities of treatment. The rate of complications was less in children who were operated on first day of admission (p=0.02). Group B and group C had 80% and 61.11% excellent results and group A had 47.05% poor results. The outcome was better with cross K wire pinning than lateral pinning (p=0.015).

Conclusions: Supracondylar fracture of humerus should be operated as early as possible to reduce the rate of complications. The outcome of surgical treatment was better than conservative treatment evaluated in terms of Flynn’s criteria. Cross wire pinning was better than lateral pinning in terms of outcome, but the rate of neuropraxias was more with cross wire pinning.


Keywords


Supracondylar humerus fractures, Elbow, Kirschner wires, Open fracture reduction, Conservative treatment

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References


Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg. 2008;90:1121-32.

Cheng JCY, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop Part B. 2001;10(1):63-7.

Picado VA, Moran G, Moraleda L. Management of supracondylar fractures of the humerus in children. British Editorial Society Bone Joint Surg. 2018;3:526-40.

Chateau FPW, McIntyre ML. An Analysis of Open Reduction of Irreducible Supracondylar Fractures of the Humerus in Children. Can J Surg. 1998;41(2):112-8.

Weiland AJ, Meyer S, Tolo VT, Berg HL, Mueller J. Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years. J Bone J Surg. 1978;60(5):657-61.

Gartland JJ. Management of Supracondylar Fractures of the Humerus in Children. Surg Gynecol Obs. 1959;109(2):145-54.

Landin LA, Danielsson LG. Elbow fractures in children: An epidemiological analysis of 589 cases. Acta Orthop. 1986;57(4):309-12.

Ramsey RHGJ. Immediate open reduction and internal fixation of severely displaced supracondylar fractures of the humerus in children. Clin Orthop Relat Res. 1973;90:131-2.

Mazda K, Boggione C, Fitoussi F, Penneçot GF. Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children. J Bone J Surg. 2001;83(6):888-93.

Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998;18(1):38-42.

Delniotis I, Dionellis P, Gekas CC, Arapoglou D, Tsantekidis D, Goulios V, et al. Flexion-type supracondylar humeral fracture with ulnar nerve injury in children: two case reports and review of the literature. Am J Case Rep. 2020;21:e921293-1–e921293-6.

Pham TT, Accadbled F, Abid A, Ibnoulkhatib A, Iniguez BX, Wargny M, et al. Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount’s method effective and safe. J Shoulder Elb Surg. 2017;26(12):2226-31.

Muccioli C, Batti ES, Oborocianu I, Rosello O, Solla F, Chau E, et al. Outcomes of Gartland type III supracondylar fractures treated using Blount’s method. Orthop Traumatol Surg Res. 2017;103(7):1121-5.

Ducic S, Bumbasirevic M, Radlovic V, Nikic P, Bukumiric Z, Brdar R, et al. Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches. Srp Arh Celok Lek. 2016;144(1-2):46-51.

Li M, Xu J, Hu T, Zhang M, Li F. Surgical management of Gartland type III supracondylar humerus fractures in older children: A retrospective study. J Pediatr Orthop Part B. 2019;28(6):530-5.

Gowda PM, Mohammed N. A Study of Supracondylar Fractures of Humerus in Children by Open Reduction and Internal Fixation with Kirschner Wires. Indian J Clin Pract. 2014;25(6).

Zionts LE, Kellop MHA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone J Surg. 1994;76(2):253-6.

Naik LG, Sharma GM, Badgire KS, Qureshi F, Waghchoure C, Jain V. Cross pinning versus lateral pinning in the management of type III supracondylar humerus fractures in children. J Clin Diagnos Res. 2017;11(8):3-5.