Supracondylar fractures of the humerus in children-an analysis of different treatment modalities at the age khan University Hospital

ABSTRACT

From October 1986 to September 1990, 50 pediatric patients aged 2 to 13 years with supracondylar fractures of the humerus were admitted to the Aga Khan University Hospital for treatment. Three patients had open fractures. Forty Seven had closed fractures. Of the latter 45 were reviewed retrospectively. Four different treatment modalities were used in this group of patients. Five patients with undisplaced or minimally displaced fractures [Gartland's type I] had satisfactory end results with plaster splint immobilization without manipulation. Twenty patients with displaced fractures [14 Gartland's type II and 6 type III] were treated with closed manipulative reduction and immobilization with a plaster splint under general anaesthesia. Of these, nine [45%] had an initial anatomical reduction but healing of the fracture in that position occurred only in 5 patients [25%]. The remaining 13 patients [55%] had some radiological deformity at the conclusion of healing, but a significant cosmetic defect [a change of the carrying angle leading to cubitus varus of 5 - 15 degrees] was noted in only 5 patients [25%]. Ten patients with severely displaced fractures [Gartland's type III] required open reduction and internal fixation because of failure of closed reduction under general anaesthesia. Two patients [20%] had a significant change of the carrying angle of the upper extremity - a loss of nine degrees of carrying angle in one and cubitus varus of 4 degrees in the other. From January 1990 ten consecutive patients with severely displaced supracondylar fractures [one Gartland's type II and 9 type III] were treated by closed reduction with percutaneous pin fixation. An anatomical reduction was obtained and maintained in all patients without any complications. This method has been adopted as the method of choice at the Aga Khan University Hospital and a protocol has been established for its use. A detailed description of the operative technique is provided