[Modified dorsal approach to supracondylar humerus fractures]

The fracture line in children's supracondylar fractures of the humerus always runs through the olecranon fossa and the radial and ulnar metaphyseal columns. As the articular capsule covers the fossa, all these fractures are intracapsular fractures with haemarthrosis. They require an anatomical reduction and a safe stabilisation in order to avoid a varus deformity. The results after conservative or operative treatment of extension type fractures are only fair, and Magerl found, that 47% of the operated cases suffered a varus deformity. We modified a dorsal approach to the elbow joint, which allows us to overlook the whole joint and the fracture site. Then anatomical reduction is easy. For stabilisation we use two K-wires for the radial and another two for the ulnar column. It is no problem to use twice the number of wires compared with other operative procedures, because the whole fracture region is exposed. Thus we get better stability and avoid secondary dislocation. We used the modified dorsal approach in 13 cases during the last two years. We have obtained excellent results, but a follow-up will be necessary in three to five years.