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Supracondylar humerus fractures in children. Comparison of operative treatment methods
R T Davis1, J T Gorczyca, K Pugh
1Division of Orthopaedic Surgery, University of Kentucky College of Medicine, Lexington, USA.
Insights
Operative treatment of pediatric supracondylar humerus fractures is safe, with no cases of compartment syndrome. Crossed Kirschner wires showed lower displacement rates in Type III fractures, and long-term outcomes were generally good.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Supracondylar humerus fractures are common in children.
- Operative management is frequently indicated for these fractures.
- Potential complications include compartment syndrome and Volkmann's ischemic contracture.
Purpose of the Study:
- To evaluate the outcomes of operative treatment for pediatric supracondylar humerus fractures.
- To assess the incidence of early postoperative displacement and long-term complications.
- To compare the efficacy of different Kirschner wire stabilization methods.
Main Methods:
- Retrospective analysis of 87 pediatric patients.
- Operative treatment by 18 surgeons over 6 years.
- Assessment of early displacement, long-term functional outcomes, and radiographic alignment.
Main Results:
- No cases of compartment syndrome or Volkmann's ischemic contracture were reported.
- Early postoperative displacement occurred in 7% of Type III and 4% of Type II fractures.
- Crossed Kirschner wires demonstrated a lower displacement rate (2%) compared to lateral wires only (28%) for Type III fractures.
- Long-term follow-up (average 33 months) showed excellent or good results in 77% of patients.
- Gunstock deformity occurred in 13% of patients, but did not compromise function or range of motion.
Conclusions:
- Operative management of pediatric supracondylar humerus fractures is associated with a low risk of severe complications.
- Crossed Kirschner wire fixation appears to be a reliable method for stabilizing Type III fractures.
- While gunstock deformity can occur, it typically does not lead to functional deficits.
Abstract:
A retrospective analysis was performed of 87 children treated operatively for supracondylar humerus fractures by 18 different surgeons during a 6-year period. No patient suffered from compartment syndrome or Volkmann's ischemic contracture. Early postoperative fracture displacement occurred in four (7%) of 60 patients with Type III fractures, and in one (4%) of 23 patients with Type II fractures. Displacement occurred in one (2%) of 52 Type III fractures stabilized with crossed medial and lateral Kirschner wires, whereas displacement occurred in two (28%) of seven Type III fractures stabilized with lateral wires only. Thirty-four patients could be located for long-term followup; complete examination of both upper extremities was performed on these 34 patients at an average of 33 months postoperatively. The long-term results were excellent in 19 (56%), good in seven (21%), fair in one (3%), and poor in seven (21%) patients. Five additional patients were not available for followup at the time of the current study, but had followup of at least 6 months available. Of the 39 patients with followup of at least 6 months, five patients' fractures (13%) healed with coronal plane malalignment greater than 10 degrees which resulted in gunstock deformity. There was no statistically significant relationship between treatment method and gunstock deformity. However, none of the patients with gunstock deformity had compromised activity because of the deformity, and all had full elbow extension and at least 130 degrees elbow flexion.
