Lateral External Fixation-A New Surgical Technique for Displaced Unreducible Supracondylar Humeral Fractures in Children

Abstract

The use of a small lateral external fixator seems to be a safe alternative for the treatment of displaced supracondylar fractures of the humerus when a closed reduction appears to be unattainable by means of manipulation alone or when sufficient stability is not achieved with standard methods of Kirschner wire fixation.

Pitfalls of lateral external fixation for supracondylar humeral fractures in children

“…The external fixator has been shown to be an additional treatment option for supracondylar humeral fractures in children. Our data support the recommendations of Slongo et al [6]; the main indications are fractures of the distal humerus, which potentially remain unstable with classical methods (mainly type III fractures and oblique fractures in the sagittal plane), fractures that are irreducible when the usual techniques are applied, and secondary dislocated Unsatisfactory Poor 4 -fractures after closed reduction and unilateral percutaneous pinning. Nevertheless, we observed neurological complications in 10% of our patients, questioning the safety of this method.…”

“…Thirty-one children with Gartland type III fractures were treated with good results. No major complications occurred, and they concluded that lateral external fixation is a safe alternative for the treatment of displaced supracondylar fractures when closed reduction appears to be unattainable by means of manipulation alone, or when sufficient stability is not achieved with standard methods of K-wire fixation [6]. Our own experience coincides with theirs, and overall results of long-term outcome in our patients with unstable or markedly displaced supracondylar fractures were good to excellent.…”

“…The method was described as simple and versatile, combining the advantages of traction and surgical fixation. In 2008, Slongo et al [6] published their experience with lateral external fixation, which is comparable to the method described in this paper. Thirty-one children with Gartland type III fractures were treated with good results.…”

“…Taller introduced the use of an external fixator for supracondylar fractures of the humerus in children in 1986 [5]. In 2008, Slongo published his series of Gartland type III supracondylar humeral fractures treated with a lateral external fixator, and this technique has been promoted as a safe alternative to Kirschner wire fixation [6]. In contrast to Slongo's series with no neurological complications, we observed radial nerve injuries in our patients.…”

“…External fixation is a well-established method for the treatment of fractures at different locations, and has also been advocated in supracondylar fractures of the humerus [5,6].…”