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Pediatric supracondylar humerus fractures: the anterior approach
Maarten J Koudstaal1, Victor A De Ridder, Sam De Lange
1University of Utrecht, University Medical Center, Utrecht, Medical Center Haaglanden, The Hague, The Netherlands.
Objectives:
To evaluate the efficiency of the anterior approach for displaced supracondylar pediatric humeral fractures.
Design:
A retrospective analysis.
Setting:
Clinical and outpatient clinic care.
Patients:
The anterior approach group consisted of twenty-six patients. The historical group consisted of thirty-two patients. All had a completely displaced extension-type supracondylar humerus fracture (Gartland Type III). All were operated within six hours of admission. All patients were contacted; twenty-five of the twenty-six and twenty-nine of the thirty-two patients were re-examined at the outpatient clinic. The other patients were contacted by telephone.
Intervention:
All fractures in the anterior approach group were operated through a ventral approach: An incision was made in the cubital fossa of only the skin and subcutaneous tissue, and reduction was performed with the thumb and index finger. The fractures in the historical group were approached through a lateral or a combined lateral and medial approach. For each case in both groups fixation was done with crossed percutaneous K-wires followed by plaster of Paris splinting for two weeks. Radiographic and clinical results were evaluated in follow-up examinations.
Main Outcome Measurements:
Functional and anatomic measurements were obtained at follow-up.
Results:
In both groups no compartment syndrome or Volkmann's ischemic contracture was seen. Two in the anterior approach group and one in the historical group had an associated brachial artery injury. Early postoperative fracture displacement occurred in one of the twenty-six anteriorly approached and in four of the thirty-two historical group patients. One of the four patients in the historical group with early displacement had no cosmetic or functional loss during follow-up examinations. One patient in the anterior approach group and two patients in the historical group had a rotational deformity, one of whom also suffered a functional loss. The only other functional losses were found in two patients in the anteriorly approached group and in three patients in the historical group.
Conclusions:
The results of this study show that the anterior approach is safe, simple, and easy to perform. The anterior approach has good and excellent results by Flynn's criteria in 84 percent versus 75 percent in the control group (p = 0.56).