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Operative reduction and fixation of a difficult supracondylar extension fracture of the humerus
Insights
Operative treatment using the anterior cubital approach for difficult pediatric elbow fractures is safe and effective. This method yielded superior anatomical results compared to traction, with minimal complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Supracondylar elbow fractures are common in children.
- Difficult fractures often involve complete humerus dislocation.
- Treatment options include operative intervention and traction.
Purpose of the Study:
- To evaluate the outcomes of operative treatment for difficult pediatric supracondylar elbow fractures.
- To compare the anterior cubital approach with traction therapy.
- To assess functional and anatomical results and complications.
Main Methods:
- Retrospective analysis of 45 consecutive pediatric patients.
- 32 patients treated with early operative reduction and fixation via anterior cubital approach.
- 13 patients treated with traction.
Main Results:
- Both methods preserved range of motion, but traction led to more reduced carrying angles.
- No permanent nerve dysfunction, keloid, or myositis ossificans occurred.
- Operative fixation had complications like osteosynthesis slippage and ulnar nerve entrapment, but no infections.
Conclusions:
- The anterior cubital approach for difficult pediatric supracondylar humerus fractures is safe and efficient.
- Operative reduction and fixation offer superior anatomical outcomes compared to traction.
- Early complications are related to fracture fixation, not the surgical approach itself.
Abstract:
We evaluated the results of the operative treatment of a difficult supracondylar fracture of the elbow. A series of 45 consecutive children, the majority presenting initially with a complete dislocation of the humerus, was reexamined. Thirty-two of the patients had undergone an early operation applying the anterior cubital approach and 13 patients had been treated by traction. The lengths of the follow-up periods were 3.1 +/- 1.5 and 8.8 +/- 2.6 years, respectively. Normal range of extension-flexion and rotation movements was preserved almost invariably by either modality of therapy, whereas the carrying angle of the elbow was reduced significantly more often in the group treated by traction. None of the patients presented with permanent nerve dysfunction, keloid formation, or myositis ossificans. The two preventable early complications, slipping of the osteosynthesis and entrapment of the ulnar nerve, were related to the fixation of the fracture. There were no early or late infectious complications. When the anterior approach was used, operative reduction and fixation of a difficult supracondylar fracture of the humerus proved to be both safe and timesaving. Anatomical results of operation were superior to those attained by traction therapy in our series.