Management of grade III supracondylar fracture of the humerus by straight-arm lateral traction

Abstract

Supracondylar fracture of the humerus is a common upper limb fracture in children for which treatment is controversial and often technically difficult, and complications are common. Cubitus varus is the most prevalent complication encountered in such fractures, with a mean incidence rate of 30%. A variety of methods for treating displaced fractures have been recommended. We reviewed 20 cases of severely displaced grade III supracondylar fractures of the humerus in children. There was marked swelling and distorted local anatomy in all these fractures, which were managed conservatively with straight-arm lateral traction. The patients were treated in skin traction for 2 weeks, following which they commenced physiotherapy. The traction was applied with the arm at 90 degrees of abduction and the forearm in supination. None of the patients developed any complication, and all had the full range of movements. None had cubitus varus deformity, and none of these patients required further surgical treatment. There was a complete patient and parent satisfaction. Open or closed reduction with internal fixation is the most common method of treating these injuries, however in some cases this can be very difficult and dangerous. If the local anatomy and swelling do not allow this treatment then non-operative measures have to be adopted. We conclude that straight-arm lateral traction is a safe and effective method of treating these fractures, especially when the local anatomy is disturbed and the swelling makes operative intervention relatively more risky and difficult. Moreover, this method is also appropriate in areas where access to specialised centres in treating these injuries is either difficult or delayed.

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

“…Type III and type IV (described by Leitch et al [15] as being like fractures with multidirectional instability) are considered to be totally displaced with an incidence of 16.7% [16,17].…”

“…Severely displaced SCHF are challenging injuries to treat [16,[18][19][20] and entail technically difficult procedures for orthopedic surgeons [7,10]. There remains controversy in the literature with regards to the definitive management of these type of fractures [16,21,22].…”

Operative management of type III extension supracondylar fractures in children

“…Many methods have been recommended for the treatment of type III fractures including closed reduction and cast immobilisation, traction by various methods and reduction via closed or open means and fixation by Kirschner (K-) wires [1,[11][12][13][14][15]. The aim of this study was to evaluate the outcomes of two different treatment options (primarily closed reduction and percutaneous pinning versus primarily open reduction with pinning) for type III extension fractures performed at two different institutes.…”

Gartland Type Iii Supracondylar Fracture Humerus; Surgical Management

“…2 The management of supracondylar fracture of humerus is controversial and technically difficult and complications are common. 5 The purpose of this study was to assess the ability of open reduction and internal fixation by K-wire to obtain and maintain an adequate fixation, and to evaluate the recovery of elbow range of motion (ROM) and carrying angle.…”