Surgical management of Gartland type III supracondylar humerus fractures in older children: a retrospective study

Abstract

The aim of this study was to analyse the management of Gartland type III supracondylar humerus fractures in children older than 10 years at our paediatric orthopaedics and to determine the clinical and radiographic long-term effects following open reduction by the small medial approach and cross-fixation with three kirschner wires. Eighty-three cases of Gartland type III supracondylar humerus fractures in children older than 10 years were treated by open reduction by the small medial approach and cross-fixation with three kirschner wires from January 2010 to December 2015. All patients were followed up from 12 to 15 months (mean: 13 months). Assessments after 1 year included neurovascular examination, Flynn’s criteria (elbow function and carrying angle), pain and complications (infections, growth disturbances or iatrogenic nerve injuries). All fractures healed within 2 months. According to Flynn’s criteria, 80 (96.4%) patients achieved satisfactory outcomes, whereas three (3.6%) were graded as unsatisfactory because of limited elbow motion. The mean carrying angle measured 9.4° (1°–16°) compared with 10.8° on the contralateral side (5°–16°). No case of cubitus varus was noted. No wound infection and displacement of bone fracture occurred. No case of iatrogenic ulnar nerve injury and vascular deficits was noted. There were no cases of myositis ossificans or Volkmann’s ischaemic contracture. It is safe and effective to treat Gartland type III paediatric supracondylar humerus fractures in older children with open reduction by the medial approach and crossed K-wires fixation.

Are Modified Gartland Type IV Supracondylar Humerus Fractures Different From Type III Fractures? A Retrospective Clinical Study

“…The results of the present study were found to be compatible with the literature, for both groups. [16][17][18][19].…”

A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

“…(Table 5). 15 In a study done by Gowda et al, all 50 patients who were treated by open reduction and internal fixation with K-wire had reported 10% of ulnar nerve palsy and 83.3% had excellent/good outcome. 16 In a study done by Mazda et al, 92% of children who had undergone open reduction with internal fixation had excellent outcome according to Flynn criteria.…”

Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures

“…Discussions regarding the potential risk of ulnar nerve injury in case of medial pinning and the insufficiency of lateral pinning alone in providing stability compared to cross pinning are still ongoing [20,21]. Li et al performed a medial incision and inserted one K-wire from the medial aspect and two K-wires from the lateral aspect, and they did not report any complications such as ulnar nerve injury, compartment syndrome, or varus deformity during the follow-up of 83 patients >10 years, and they obtained satisfactory functional and cosmetic outcomes [22]. Lateral pinning was reportedly performed in 48 patients and cross pinning in 39 patients following closed reduction, and cross pinning reportedly provided a more rigid fixation [23].…”