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Delayed open reduction for supracondylar fractures of the humerus
Insights
Delayed open reduction for severe humerus fractures in children is safe and effective. This approach, using a posterior V-Y plasty, facilitates fragment alignment and minimizes cubitus varus deformity, with no increased risk of myositis ossificans.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Supracondylar humerus fractures are common in children.
- Grade IV fractures often present with significant swelling, delaying surgical intervention.
- Delayed treatment can raise concerns about complications like myositis ossificans and poor outcomes.
Observation:
- Twenty children with grade IV supracondylar humerus fractures underwent open reduction 11-17 days post-injury.
- Surgical delay was attributed to persistent edema and soft tissue compromise.
- A posterior surgical approach with V-Y triceps plasty was utilized.
Findings:
- Most patients achieved a useful range of motion post-operatively.
- No significant complications were reported in the study cohort.
- The posterior approach aided in accurate fragment alignment.
- Cubitus varus incidence was reduced with this technique.
Implications:
- Delayed open reduction is a viable option for managing severe pediatric humerus fractures when initial swelling precludes early surgery.
- The posterior V-Y plasty technique is effective for achieving anatomical reduction and preventing angular deformities.
- Concerns regarding iatrogenic myositis ossificans following delayed treatment appear unwarranted.
Abstract:
Twenty children with grade IV supracondylar fractures of the humerus had an open reduction 11 to 17 days after injury. The delay was due to swelling and blisters. Most patients recovered a useful range of movement and there were no complications. A posterior approach with V-Y plasty of the triceps makes it easy to align the fragments and reduces the incidence of cubitus varus. Apprehension about the risk of increasing the extent of myositis ossificans is unfounded.