Descriptive Study on Epidemiology, Clinical Presentation, Treatment, and Outcome of Supracondylar Fractures Treated in a Base Hospital of Sri Lanka: A Single-Center Study

Abstract

Introduction: Supracondylar fractures are common pediatric elbow injuries, with management in developing countries presenting challenges due to limited resources, inadequate facilities, and a lack of trained personnel. Method: This study aimed to describe the incidence, demographics, clinical presentation, treatment methods, and outcomes of supracondylar fractures treated at Ashraff Memorial Hospital (AMH)-Kalmunai, a base hospital in Sri Lanka. This is a retrospective descriptive study conducted between January 2019 and December 2020. Results: The study involved 79 children with supracondylar fractures. The majority of the children were male (70.9%) and their ages ranged from one to 15 years. The study identified falls as the most common presenting complaint (92.4%), followed by road traffic accidents (3.8%), native treatment (2.5%), and mismanagement (1.3%). The majority of fractures affected the right side (69.6%), while the remaining cases involved the left side (30.4%). Regarding the time duration from fracture to hospital presentation, a significant proportion of children sought medical attention on the same day (51.9%), followed by presentations within the first three days (38%), within a week (5.1%), or after a month (3.8%). Based on the Gartland classification, type I fractures accounted for 44.3% of cases, followed by type II fractures (29.1%) and type III fractures (26.6%). The most common treatment approach was closed reduction and percutaneous pinning (41.8%). Other treatment options included plaster of Paris (POP) cast without manipulation (36.7%), POP cast with manipulation (7.6%), analgesics alone (6.3%), and open reduction fixation (5.1%). Follow-up procedures varied, with routine cast removal (11.4%), routine cast and K-wire removal (45.6%), and re-do surgery with routine follow-up (1.3%). Among the type III fractures, two children presented with vascular compromise and anterior interosseous nerve (AIN) impairment, while another two children had AIN impairment only. Type I and type II fractures did not exhibit nerve involvement or vascular impairment. Only one out of the 79 children had an open fracture. Conclusion: Supracondylar fracture is the most common orthopedic fracture in children. The study sheds light on the challenges and opportunities associated with treating pediatric supracondylar fractures in a resource-constrained context. The findings can help produce guidelines for the management of supracondylar fractures in underdeveloped nations, as well as contribute to global efforts to enhance the management of pediatric fractures.

Epidemiology of Supracondylar Fractures of the Humerus in Children

“…Supracondylar fractures can be caused by low-and high-energy mechanisms. In our study, the primary mechanism associated with fractures was a fall from standing height on the outstretched hand, which is consistent with the findings of Mubarak et al 6 and Wu et al 7 However, the exact activity being performed during the fall was not specified. For our analysis, we categorized fractures based on fall height: a short distance or standing height (<1 m) or from a greater height (>1 m).…”

“…Supracondylar fractures in children can be categorized into two main types: (1) extension, in which the humerus is pushed backward at the elbow joint (accounting for 98% of cases) and can be classified using the Gartland system; and (2) flexion. Among extension fractures, type I fractures, considered simpler and conservatively treatable, are most common, representing 40-64% of cases depending on the study 1,3,4,6,14,15 . Schuller et al 3 reported an incidence of 56% for type I, 17.9% for type II, 11.1% for type III, and 14.9% for type IV.…”

“…Supracondylar fractures predominantly occur in boys [3][4][5][6][7] and are more common on the left or non-dominant limb 5 . They can result from both low-energy impacts, such as falls from standing height, or high-energy traumas, such as those associated with sports activities.…”

Evaluating the Clinical Utility of Brachial Plexus Block for Reducing Opioid Exposure in Pediatric Elbow Fracture Surgery: A Retrospective Cohort Study

“…They are diagnosed by clinical assessment with radiological imaging, including simple radiographs or CT scans, to determine the type of fracture and assess associated injuries [ 12 ]. Conservative treatment, such as closed reduction and immobilization, is usually sufficient for minimal fractures, whereas more displaced cases may require CRPP if surgical treatment is required [ 2 , 3 ]. CRPP is a relatively standardized surgical technique for the treatment of pediatric elbow fractures and has shown favorable postoperative results [ 18 ].…”

“…The most common types of elbow fracture are supracondylar humerus fractures (SCHF), followed by lateral condylar fractures (LCF), and radial neck fractures (RNF). In children, these can be treated with closed reduction and percutaneous pinning (CRPP), if surgical treatment is indicated [ 2 , 3 ]. In pediatric elbow fractures with CRPP, intravenous opioid analgesics are commonly used for acute postoperative management of moderate to severe pain [ 4 ].…”