Low incidence of flexion-type supracondylar humerus fractures but high rate of complications

Abstract

Background and purpose - Supracondylar humerus fractures are the most common type of elbow fracture in children. A small proportion of them are flexion-type fractures. We analyzed their current incidence, injury history, clinical and radiographic findings, treatment, and outcomes. Patients and methods - We performed a population-based study, including all children <16 years of age. Radiographs were re-analyzed to include only flexion-type supracondylar fractures. Medical records were reviewed and outcomes were evaluated at a mean of 9 years after the injury. In addition, we performed a systematic literature review of all papers published on the topic since 1990 and compared the results with the findings of the current study. Results - During the study period, the rate of flexion-type fractures was 1.2% (7 out of 606 supracondylar humeral fractures). The mean annual incidence was 0.8 per 105. 4 fractures were multidirectionally unstable, according to the Gartland-Wilkins classification. All but 1 were operatively treated. Reduced range of motion, changed carrying angle, and ulnar nerve irritation were the most frequent short-term complications. Finally, in the long-term follow-up, mean carrying angle was 50% more in injured elbows (21°) than in uninjured elbows (14°). 4 patients of the 7 achieved a satisfactory long-term outcome according to Flynn's criteria. Interpretation - Supracondylar humeral flexion-type fractures are rare. They are usually severe injuries, often resulting in short-term and long-term complications regardless of the original surgical fixation used.

Figure 1.

The primary radiographs (anterior-posterior and lateral projection) of all flexion-type supracondylar humerus fractures (cases I–VII) during the 10 years of the study period (2000–2009). Postoperative radiographs and the radiographs at the last short-term follow-up visit are also presented.

Figure 2.

A radiographic investigation (antero-posterior and lateral projections) of the elbow showing an increased carrying angle 9 years after the injury. The patient (case IV) was 14 years old when he sustained a Gartland-Wilkins type-IV supracondylar humerus fracture.