Anterior Versus Posterior Surgical Approaches to Pediatric Supracondylar Humerus Fracture
Insights
Comparing surgical approaches for pediatric Gartland type III humerus fractures, this study found both anterior and posterior methods yield satisfactory outcomes. Surgeon preference and patient factors should guide the choice for treating these common childhood injuries.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
Background:
- Gartland type III supracondylar humerus fractures are common pediatric injuries requiring surgical intervention.
- Surgical treatment efficacy for these fractures is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the efficacy of anterior versus posterior surgical approaches for treating pediatric Gartland type III supracondylar humerus fractures.
- To evaluate outcomes including range of motion, complications, and functional/cosmetic results.
Main Methods:
- Retrospective analysis of 48 pediatric patients (<10 years) with Gartland type III fractures.
- Patients treated with either anterior (n=23) or posterior (n=25) surgical approaches.
- Assessment of elbow range of motion, complications, and functional/cosmetic outcomes using Flynn's criteria at 3 and 6 months post-surgery.
Main Results:
- No significant differences in age or gender between groups.
- The anterior approach showed a transient advantage in extension at 3 months, but no significant differences in flexion, pronation, or supination were observed at any time point.
- Both groups demonstrated significant ROM improvements from 3 to 6 months, though slightly below normative values. Overall complication rates were low and comparable (anterior: 8.70%; posterior: 12.00%), with no significant differences in functional or cosmetic outcomes based on Flynn's criteria.
Conclusions:
- Both anterior and posterior surgical approaches are effective for pediatric Gartland type III supracondylar humerus fractures.
- The choice between anterior and posterior approaches should be individualized based on patient factors and surgeon preference.
Objectives:
Gartland type III supracondylar humerus fractures frequently occur as traumatic injuries in children and often require surgical intervention. This study aimed to compare the efficacy of anterior and posterior surgical approaches to treating these fractures.
Methods:
This retrospective study analyzed 48 patients under the age of 10 with Gartland type III fractures. These patients were treated with either the anterior (n=23) or the posterior approach (n=25). At three and six months post-surgery, elbow range of motion (ROM), complications, and functional/cosmetic outcomes were assessed using Flynn's criteria.
Results:
No significant differences were found between the groups regarding age or gender. At three months, the anterior group showed significantly better extension (-8.26° vs. -13.20°, P=0.032), but this difference was not significant at six months. No significant differences were observed in flexion, pronation, or supination at any time point. Both groups showed significant ROM improvements from three to six months (P<0.001); however, these improvements were slightly below the normative values (P<0.05). The overall complication rates were low and comparable between the two approaches (anterior: 8.70%; posterior: 12.00%; P=0.700), primarily comprising reversible ulnar nerve injuries and superficial infections. Furthermore, based on Flynn's criteria, there were no significant differences in functional or cosmetic outcomes, with most patients achieving excellent or good results in both groups.
Conclusion:
Both anterior and posterior approaches for pediatric Gartland type III supracondylar humerus fractures resulted in satisfactory outcomes. Therefore, the choice of surgical approach will depend on patient-related factors and surgeons' preferences.
