Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach: an investigation of clinical and radiographical results

Background and Objective: Supracondylar fracture of the humerus is the most common elbow fracture in children. This fracture needs immediate diagnosis and treatment, otherwise, it may lead to significant neurovascular and functional problems. The aim of this study was to assess the short term outcome of displaced supracondylar fracture of the humerus in children by open reduction and pining from lateral approach.

Methods: During a period of 15 months from June 2012 to September 2013, 48 patients (25 boys and 23 girls) less than 10 years old were enrolled in the study. Inclusion criteria were extension type supracondylar fractures of humerus, Gaartland type III that closed reduction was unsuccessful and failed as the initial treatment. The clinical and radiographic results of the treatment using open reduction and internal fixation by lateral pinning were evaluated. Outcomes were assessed according to the Flynn’s criteria.

Results: The average age of the patients was 6.3 years. The most prevalent range of age was found about 6-9 years old. All patients had extension type fracture (Gartland type III). Overall, 47 (98%) patients had closed fracture and only one (2%) had open fracture. Eighteen patients (37.5%) and 30 patients (62.5%) had involvement of the dominant and non-dominant extremity respectively. No vascular injury and infection was seen in patients. One patient (2%) was identified with the radial nerve injury which, recovered after three months. In the three and six month follow-up, one patient (2%) was found with the median nerve injury. Since 15 patients were lost to follow-up, the analysis of the clinical and radiographical results at the end of the 6th month were done for 33 patients. According to the Flynn’s criteria, the cosmetic results in 30 out of 33 patients that completed their follow-up (90.09%) were excellent, in 2 patients (6.1%) were good and one case (3%) was fair (P=0.051). Also, the functional results in 31 patients (93.9%) were excellent and in 2 patients (6.1%) were good. Overall, all cases were graded satisfactory (P=0.047).

Conclusions: Treatment of the supracondylar humeral fracture in children by open reduction and internal fixation through lateral pinning is a safe approach with predictable good clinical and radiographical results.