Treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of humerus in children / 中国修复重建外科杂志

ABSTRACT

Objective: To analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children. Methods: Between January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years (mean, 5.7 years). The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours (mean, 4.6 hours). All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed. Results: The operation time was 16-52 minutes (mean, 32 minutes). The perspective frequency was 4-17 times (mean, 6.7 times). The hospitalization time was 3-7 days (mean, 4 days). All the 45 cases were followed up 8-20 months (mean, 12 months). The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in 1 case, and the excellent and good rate was 92.3%. Conclusion: Gartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.