gms | German Medical Science

Objectives/Interrogation: Supracondylar humerus fracture is the most common fracture around elbow in children. Closed reduction and percutaneous Kirschner wire fixation is a standard method of managing displaced extension type (Gartland Type II and Type III) supracondylar humerus fractures. In our hospital, we perform these operations as much as possible on the day of injury. We hypothesized that emergency operation for this fracture might bring more feasible results.

Methods: Twenty male and five female children injured with supracondylar humerus fracture were included in this retrospective study. The patients' age was averaged 6 (ranged 3-10) and the follow up period was averaged 20 months (ranged 3-56). 10 patients were distributed as Gartland type II and 15 patients were Type III. Percutaneous Kirschner wire fixation after closed reduction under general anesthesia was performed on the day of injury for 21 patients (emergency group) and on the following day for 4 patients (control group). Operations were performed in the spine position for 8 patients (group S) and in the lateral recumbent position using with the reduction bar for 17 patients (group L). We evaluated for the difference of operation time, carrying angle, forward tilting angle and Flynn's criteria at the time of final follow up between each groups.

Results and Conclusions: In previous reports, performing operation on the day of injury with supracondylar humerus fracture in children reduced complications such as compartment syndrome and facilitated the reduction. But there were no significant differences of these outcomes between emergency group and control group. There was a tendency that the average of operation time of group S was slight longer than that of group L. Forward tilting angle of group S was smaller than that of group L (p<0.05: statistically significant). Regarding to the Flynn's criteria, 22 patients were excellent, one patient in the control group was good and the other patients with neurological symptoms at the first visit were fair. We thought that there were some difficulties of the bending reduction for the fracture in the lateral recumbent position. Reduction bar would inhibit the bending reduction and this incomplete reduction might become the result of small tilting angle. An operation in the spine position is desirable if we aim at the more feasible flection. But the results of Flynn's criteria in the group L were almost excellent because the average of forward tilting angle was within the acceptable range.