Delayed surgical treatment of supracondylar humerus fractures in children using a medial approach

Abstract

Purpose The appropriate management of supracondylar humerus fractures in children is frequently delayed due to various factors, and there is still no agreement on the treatment of choice. The purpose of this study was to evaluate the effects of delayed treatment of displaced supracondylar humerus fractures on the treatment results and complication rate. Methods A total of 31 children with supracondylar humerus fractures who had not received adequate treatment for their displaced fractures were included in this study. The conditions leading to delayed treatment mainly included severe swelling or skin problems around the elbow and the health facility problems unique to our district. The mean delaying time was 6 days (range 2-19 days). There were 24 males and 7 females with a mean age of 7 years (range 1-13 years). The fractures were classified as type III-A (n = 15; 48%) and type III-B (n = 16; 52%) according to Gartland. Surgical treatment consisting of sentiment manual reduction through a medial approach and percutaneous cross-pinning was applied to all. No image intensifier was used during the procedures. A long-arm splint was used for post-operative immobilization. Results The average hospital stay was 2 days (range 1-3 day) and the patients were followed clinically and radiographically for an average of 4 years (range 2-11 years). Pins were removed at the end of the third week post-operatively, at which time the range of motion exercises were begun. None of the patients required physical therapy and full functional recovery was achieved within 3 months in 29 (93.5%) patients and within 5 months in the remaining 2 (6.5%). Two (6.5%) preoperative nerve injuries (1 interosseous, 1 ulnar) were resolved spontaneously within 3 months post-operatively. At the final follow-up, 7 (22.5%) patients had cubitus varus deformity. Except for 2 (6.5%) pin-tract infections, which were resolved by oral antibiotics and pin removal, none of the patients had early or late complications, not even neurological deficit or myositis ossificans. Conclusions Delayed presentation of displaced supracondylar humerus fractures in children did not increase complication rates or unsatisfactory results following an open reduction. Medial approach and cross-pinning is an effective and reliable treatment method for these fractures.

Open Reduction and K - Wire Fixation of Very Late Presenting Paediatric Suprasupra Condylar Humeral Fractures Using Inverted v - Y Tricepsplasty Approach and Callus Osteoclasis

“…The delay time ranged from 11 to 17 days. In another study by Abdullah et al, 8 the average delay time was 6 days (Range 2-19 days). In our study, inability of treating physician to achieve a satisfactory closed reduction due to continued swelling (5 cases) was the main reason for the fracture displacement in an above elbow slab and malunion.…”

“…The average time for complete union in the current study was 7.2 weeks (Range 5-10 weeks) that is comparable to a study by Dehao et al 20 In our study, the time to regain the near normal ROM ranged from 12 to 22 weeks with a mean duration of 16 weeks with faster recovery in patients with faster union and less immobilization. In the study by Eren et al 8 full functional recovery was achieved within 3 months in 29 patients (93.5%). Explanation for inferior functional result could be very late presentation (After 1 month) and extensive soft tissue dissection (Tricepsplasty).…”

“…17 and Abdullah et al in Turkey. 8 reported mean treatment delays of 4 and 6 days, respectively. A study by Lal and Bhan.…”

“…This result in malunion and shortening of triceps thus makes late reduction more difficult. 8 Surgical exposure can be accomplished by a variety of approaches. There is no clear evidence in the literature regarding which of the surgical approaches brings about the best outcomes as well as minimizing complications.…”

The Effects of Surgical Treatment on Elbow and Hand Functions in Gartland Type 3 Children’s Humerus Supracondylar Fractures with Posterior Approach

“…Hastaların Flynn kriterlerine göre fonksiyonel ve kozmetik sonuçları tablo 2 de gösterilmiştir . (Resim1a,b,c) Hastalarda ameliyat sonrası sinir arazı, kompartman sendromu, [23][24][25][26]. Akmaz ve arkadaşları yaptıkları çalışmada ilk 8 saatte ameliyat ettikleri hastalarla 8 saatten sonra ameliyat ettikleri hastaları karşılaştırmış-lar; her iki grupta da tatminkar sonuç aldıklarını bildirmişlerdir [23].…”