Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures

Skeletal traction and delayed percutaneous fixation of complicated supracondylar humerus fractures due to delayed or unsuccessful reductions and extensive swelling in children

The functional and radiological results of 13 supracondylar humerus fractures of 13 children were evaluated to determine the efficiency of delayed percutaneous fixation of the fractures after a period of skeletal overhead traction. All the fractures were complicated by delayed reduction, extensive swelling or unsuccessful reduction manipulations. As the unfavourable preexisting factors subsided under skeletal traction, anatomical reduction and fixation of fractures by percutaneous pinning were performed under general anesthesia. The average follow-up period was 21 months. Bauman and lateral capitellohumeral angles were measured and statistically analyzed. Functional and cosmetic results were evaluated by physical examination of the elbows. There were 11 excellent and two fair functional results while all cosmetic results were excellent or good. As a result, skeletal traction and delayed percutaneous pinning is accepted as an alternative method of treatment for complicated supracondylar humerus fractures in children.

The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children

BACKGROUND

The purpose of this study was to evaluate the perioperative complication rates associated with early surgical treatment (eight hours or less following injury) and delayed surgical treatment (more than eight hours following injury) of displaced supracondylar humeral fractures in children.

METHODS

Fifty-two patients had early surgical treatment and 146 patients had delayed surgical treatment of a displaced supracondylar humeral fracture. The perioperative complication rates of the two groups were compared with the use of bivariate and multivariate statistical methods.

RESULTS

There was no significant difference between the two groups with respect to the need for conversion to formal open reduction and internal fixation (p = 0.56), pin-track infection (p = 0.12), or iatrogenic nerve injury (p = 0.72). No compartment syndromes occurred in either group. Power analysis revealed that our study had an 86% power to detect a 20% difference between the two groups if one existed.

CONCLUSIONS

We were unable to identify any significant difference, with regard to perioperative complication rates, between early and delayed treatment of displaced supracondylar humeral fractures. Within the parameters outlined in our study, we think that the timing of surgical intervention can be either early or delayed as deemed appropriate by the surgeon.

Elbow Fractures in Children: Diagnosis and Management

Fractures about the elbow are very common in children, but the anatomy of the child's elbow may make the diagnosis less obvious than in a mature skeleton. An understanding of the ossification and fusion of the secondary growth centers about the elbow is essential to avoid overlooking these injuries and to optimize treatment. If plain radiographs are equivocal, an arthrogram of the elbow may clarify the anatomy and diagnosis. Early neurologic and vascular complications are not uncommon and must be recognized before fracture reduction. Many late complications, such as malunion, osteonecrosis, and physeal bridging, are largely preventable by correct early diagnosis and treatment. Anatomic reduction of articular surfaces, restoration of physeal anatomy, and near-anatomic alignment of fracture fragments in the frontal plane are the corner-stones of successful treatment of pediatric elbow fractures.

Supracondylar Fractures of the Humerus in Children

The treatment of type II and type III supracondylar fractures of the humerus in children with closed reduction and percutaneous pinning has dramatically lowered the rate of complications from this injury. The incidence rates of malunion (cubitus varus) and compartment syndrome have both decreased. Nerve injury accompanying this type of fracture (prevalence, 5% to 19%) is usually a neurapraxia, which should be managed conservatively. Vascular insufficiency at presentation (prevalence, 5% to 17%) should be managed initially by rapid closed reduction and pinning without arteriography. Persistent vascular insufficiency necessitates exploration and vascular reconstruction.