Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

Abstract

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann's angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

An engineering review of external fixators

“…An orthopaedic definition of bone fracture includes discontinuity of the bone, along with soft tissue injury and its healing is significantly influenced by the magnitude and distribution of mechanical stresses within the fracture bridging tissues [5] . EFs, which are a form of less invasive surgery, have been used as an alternative to internal fixators, which generally takes the form of plates with screws [ 6 , 7 ]. Earliest studies, both in terms of surgical [8] and mechanical [9] , identified the potential of EFs compared to plate fixation, especially in terms of its rate of healing and possible serious infections.…”