As a Definitive Choice of Treatment, Joint and Defect Spanning Multiplanar Tubular External Fixation in the Management of Pediatric Open Defective Supracondylar Humerus Fracture: A Case Report

Abstract

Introduction: Although supracondylar fractures of the humerus are common in children, open fractures of are extremely rare injuries. Gustilo- Anderson Type-III fractures in the upper extremity are primarily associated with considerable bone loss resulting from high energy trauma. In this study, a case of open pediatric supracondylar humerus fracture treated by a joint and defect spanning multiplanar tubular external fixation is presented.

Case report: A boy aged 3 years suffered from a Gustilo-Anderson Type-IIIA supracondylar humerus fractures. There was no neurovascular compromise. Intravenous antibiotic regimen was introduced. A joint and defect spanning multiplanar tubular external fixation was employed within 4 h of the accident. After the operation, the patient was closely followed in the inpatients unit. The external fixator was removed in the 6th week of follow-up, and range of motion exercises was started. With the exception of limited flexion of the elbow in 12th month of follow-up, supination and pronation were full. At the 48th month follow-up, 120° of elbow flexion, full extension, and full forearm rotation were observed. Physical examination showed 15° change in carrying angle to cubitus varus; radiologic examination showed a slight varus angulation of the distal humerus, a decreased Baumann's angle. The Mayo elbow performance score was 100 points.

Conclusion: When taking into account the high remodeling capacity, healing potential, and greater resistance to joint stiffness in fractures of children, joint and external fixators appear as a viable definitive treatment in such cases.

Keywords: Open pediatric fracture; bone loss; external fixator; supracondylar humerus.

Figure 1

(a) and (b) Anteroposterior and lateral radiographs display a 3 cm × 4 cm segment of avascular and grossly contaminated bone.

Figure 2

(a) and (b) Post-operative anteroposterior and lateral radiographs of the humerus, (c) display the fixator employed at 90° of elbow flexion, neutral forearm rotation, and proper humeral rotation.

Figure 3

Three cortices were seen in the plain radiograph.

Figure 4

(a) and (b) Figures display 120° of elbow flexion, full extension.

Figure 5

The carrying angle was 15° of a cubitus varus.

Figure 6

(a) Anteroposterior radiograph display a slight varus angulation of the distal humerus and a Lode creased Baumann’s angle,(b) lateral radiographs display a normal lateral capitellohumeral angle.