Incidence of flexion-type supracondylar fractures at a single Australian level one Paediatric Trauma Centre

Supracondylar fractures are the most common elbow fracture. There have been no studies published analysing flexion-type fractures in the Australian paediatric population. This paper aims to investigate flexion-type supracondylar fractures in an Australian paediatric population. Eight hundred and three paediatric supracondylar elbow fractures were retrospectively reviewed at one hospital over a 5 year time period. The focus was on flexion-type fractures.

Supracondylar fractures that presented to the Women's and Children's Hospital Emergency Department between 2015 and 2020 were retrospectively reviewed. Fractures were classified on plain radiographs according to the Modified Gartland Classification System. Injury and treatment data were collected for flexion-type fractures.

Twenty-one (2.6%) of fractures were flexion-type. The average age of injury was 6.8 years old. Flexion-type fractures were more common in females (62%) and with high energy mechanisms (81%). Ulnar nerve palsies occurred in five cases (24%). Two ulna nerve palsies did completely resolve at 3 months follow up. One open fracture occurred. No vascular injuries occurred. Ten of the 21 flexion-type fractures (48%) were treated surgically.

The authors conclude that: flexion fractures are uncommon, they occur more often after high energy mechanisms such as falls from monkey bars, swings, or trampolines. Flexion-type fractures occur more often in slightly older females. The ulnar nerve is most frequently injured and in the current study-exclusively injured. At 3 month follow up, spontaneous nerve recovery had occurred in three of the five cases (60%).