Medial Approach for Operative Treatment of the Widely Displaced Supracondylar Fractures of the Humerus in Children

Abstract

Twenty-seven widely displaced supracondylar fractures of the humerus in children were treated by open reduction and cross K-wire fixation by the medial approach over a 30-month period. The mean follow-up was 14 months, average age 8 years and the mean delay in presentation 49 hours. Medial approach provided an excellent view of the medial bone pathology via an internervous plane and enabled an anatomical reduction in all cases. Cross K-wire fixation obviated the need to immobilize the elbow at 90 degrees or more flexion. No postoperative neurovascular complication was noted. Most patients regained full range of motion within 6 weeks of pin removal and no change in the carrying angle was noted. Delayed presentation, repeated manipulations and massage were responsible for loss of motion. Superficial pin tract infection was noted in 5 patients and resolved with dressings and antibiotics. No deep infection occurred. Medial approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function.

Comparison of Medial and Lateral Approach for Single Incision Operative Treatment of Widely Displaced P Ediatric Supracondylar Humerus Fracture

“…Medial column comminution and internal rotation of the distal fragment predispose to the medial tilt, which causes loss of the carrying angle 4,5,[11][12][13] . This is the most common complication.…”

“…Visualization of the ulnar nerve, careful dissection and retraction eliminate the risk of ulnar nerve palsy in medial approach 4,5 . Blind pinning is generally associated with an incidence of 2-3% of temporary ulnar nerve palsy.…”

“…However, delayed presentation, absence of fluoroscopic facility and unsuccessful closed reduction requires open reduction and internal fixation by Kirshner wires (K wires) to have anatomical reduction. There are several approaches for open reduction like lateral 3 , medial 4,5 , posterior 6 and anterior 7 with their advantages and disadvantages. Posterior approach gives unsatisfactory result due restriction of range of motion.…”

Castries Prone Positioning for Open Reduction and Internal Fixation of Closed Gartland Grade III Humeral Supracondylar Fractures in Children

“…7,8 Close reduction and percutaneous pinning has been widely used, so is ORIF in the treatment of Gartland type III humeral supracondylar fracture. 2,9,10 The approaches for open reduction has been somewhat controversial with recommendation of different approaches; anterior, 11,12 medial, 13 lateral, 14 posterior, 15,16 and double incision (medial and lateral) 17 approaches have all been recommended by various investigators. The documented position has been by supine position where assistant might be required to hold and support the forearm throughout the surgical procedure.…”

open reduction and Internal Fixation of displaced Supracondylar Fractures of humerus with Crossed K-wires via Medial Approach

“…In such situations, open reduction and internal fixation with Kirschner wires (K-wires) is a safe procedure to achieve anatomical reduction and maintenance of stable alignment. Various approaches advocated for open reduction are the medial 8 , lateral 9 , combined medial and lateral 10 , posterior 11 , antero-medial and the anterior transverse. Most surgeons have given up the posterior approach due to the high incidence of elbow stiffness.…”