Nonoperative Treatment of Type IIA Supracondylar Humerus Fractures: Comparing 2 Modalities

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Traumatology

Background:

• Gartland type IIA supracondylar humeral fractures in children present treatment controversies.
• Traditional treatments include circumferential casting or closed reduction and pinning.
• Pronated flexion-taping is an alternative method used at our institution.

Purpose of the Study:

• To compare the efficacy of pronated flexion-taping versus traditional above-elbow casting for Gartland type IIA fractures.
• To evaluate radiographic maintenance of reduction using Baumann angle and lateral humeral capitellar angle (LHCA).

Main Methods:

• Retrospective comparative study (Level III evidence) of patients aged 2-8 years with type IIA fractures.
• Comparison between flexion-taping with cuff-and-collar versus traditional above-elbow casting at 90-100 degrees.
• Radiographic measurements analyzed at the termination of immobilization (3-4 weeks postreduction).

Main Results:

• 39 patients included: 16 in cast group, 23 in tape group.
• No significant difference in final LHCA (taping: 32.14±5.90 vs. casting: 28.23±7.27, P=0.81).
• No significant difference in final Baumann angle (taping: 73.41±4.03 vs. casting: 73.75±6.46, P=0.96).
• One self-limiting rash in the taping group; no major complications or surgical conversions.

Conclusions:

• Pronated flexion-taping and traditional casting achieve and maintain adequate reduction for type IIA fractures.
• Both methods demonstrated comparable radiographic outcomes and safety profiles.
• Further research is needed to assess long-term clinical outcomes, remodeling, and function.