Supracondylar Fractures of the Humerus in Children. Comparison of Results in Two Treatment Periods

Abstract

Displaced supracondylar fractures of the humerus in children may be managed with or without Kirschner-wire fixation. The results of treatment of displaced supracondylar fractures of the humerus in children were analyzed, comparing the period before and after an audit of our results in 1997. From 1998 onward a more active policy regarding the use of percutaneous Kirschner-wire fixation was adopted. We treated 33 children between 1991 and 1997 (Period 1) and 49 children between 1998 and 2004 (Period 2). In Period 1, closed reduction and plaster immobilisation was performed in 29 patients. Four received initial Kirschner-wire fixation with plaster immobilisation. Secondary dislocation necessitating re-reduction occurred in 14 patients. In Period 2 initial Kirschner-wire fixation was performed in 41 patients, of whom 23 had open reduction. The other eight had conservative treatment consisting of closed reduction and plaster immobilization, two of them needing re-reduction. This evaluation indicates that a more active policy with regard to (open) reduction with Kirschner-wire fixation in displaced supracondylar humeral fractures in children, results in less need for secondary intervention with comparable functional and cosmetic outcome.

Conservative management of displaced paediatric supracondylar fractures: a systematic review

“…We found 28 studies examining outcome data of closed reduction and casting for displaced supracondylar fractures. 17–43 This included any method of immobilisation whereby plaster of Paris was applied to the injured arm, set under any degree of flexion. Closed reduction was performed and, where specified, manipulation of the displaced injury was performed under general anaesthetic, local block or sedation.…”

Review article: Paediatric supracondylar humeral fractures: Emergency assessment and management

“…Gartland type III fractures almost always require K‐wire fixation as it is rarely possible to control these fractures in a hyperflexed position alone. In the majority of cases closed reduction of the fracture is possible, though incidences of fractures requiring acute open reduction before pinning have been reported in approximately 20% of patients with some series approaching nearly 50% open reduction 6,26 …”

“…In the majority of cases closed reduction of the fracture is possible, though incidences of fractures requiring acute open reduction before pinning have been reported in approximately 20% of patients with some series approaching nearly 50% open reduction. 6,26 Rarely, these fractures can be too unstable or comminuted for K-wire fixation to hold the reduction and traction management is necessary. Indeed straight arm traction first described in 1939 was a standard for management of these injuries.…”

Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome

“…Closed reduction and pin fixation is generally accepted as the treatment modality of choice for displaced fractures [5][6][7][8]. However, due to insufficient closed reduction, conversion rates to open surgery are known to reach 70 % according to the literature [9][10][11][12].…”