[Treatment of supracondylar humerus fractures in children, according to Gartland classification]

Abstract

Supracondylar fractures are the most common fractures in the area of elbow in children. The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood. There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002. Ninety fractures were extension-type injuries, 3 were flexion injuries, these were not included in our study. Supracondylar humerus fractures were classified according to Gartland classification. Type III fractures were found in 63 patients, type II fractures were seen in 23 patients and 4 patients had type I fractures. Indications for treatment were determined according to fracture type. Four children were treated with external immobilization alone. Twenty-three patients underwent closed reduction and percutaneous pinning by K-wires. Sixty-two patients were treated with closed reduction and external immobilization such as a plaster cast or according to Blount. Eleven of these 62 children (type III) underwent close or open reduction and internal fixation in follow-up. In 1 case of comminutive fracture a patient underwent immediate operation. There were no early or late complications. All operated patients healed without sequela and had excellent or good results. We had noticed that all manipulations should be performed immediately in order to avoid severe swelling and neurological or vascular complications. In type I fractures we performed the external immobilization only. Type II displaced fractures can be treated satisfactorily with closed reduction and external immobilization. Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance. It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture. Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture.