[Predicting growth patterns after supracondylar fracture of the humerus in childhood]

Supracondylar fracture of the humerus is the most frequently investigated fracture in children. However, systematic studies about postoperative growth patterns cannot be found in the literature. In this retrospective study, the authors attempt to delineate the configuration of supracondylar fractures which allow spontaneous correction of a malalignment or cause post-traumatic growth disturbances. The study included 256 children with supracondylar fracture of the humerus: 184 of them (71.9%) were available for longterm follow-up. The plain films of these children were reviewed and the Baumann and shaft-capitulum angles recorded. Spontaneous correction of a primarily displaced fracture was found in 13.0% ( n=21) of all fractures in the sagittal plane. Spontaneous correction in the frontal plane could not be shown. Growth disturbance was discovered in 10.5% ( n=16) in the frontal plane. No growth disturbance was demonstrated in the sagittal plane. The relatively small number of growth disturbances can be attributed to the low growth potential of the distal physeal plate of the humerus. Growth disturbances with secondary rotational errors were not observed in this study. Spontaneous corrections of alignment in the sagittal plane are only possible under a certain age. Spontaneous correction in the frontal plane, however, is inadequately assessed with this study. The design of a prospective study was formulated to assess how to improve the therapeutic management of supracondylar fractures and to answer additional open questions. Follow-up radiographs and standardized clinical evaluations have to be performed at the time of first free range of movement and 2 years after the trauma. This study will investigate whether therapeutic progress at follow-up is better evaluated with radiological or clinical means.