Clinical results of closed versus mini-open reduction with percutaneous pinning for supracondylar fractures of the humerus in children: A retrospective case-control study

Abstract

To compare the clinical outcomes of 2 procedures, closed or mini-open reduction with percutaneous pinning (ORPP), for the treatment of supracondylar fractures of the humerus in children.Patients aged less than 15 years who had undergone surgery for supracondylar fracture of the humerus between 2004 and 2013 were identified. The case records and radiographs from 34 patients were reviewed. Twenty-one patients had undergone closed reduction followed by percutaneous pinning (CRPP), while 13 had undergone mini-open reduction through the anterior approach with percutaneous pinning (mini-ORPP). The average age of the patients at the time of surgery was 5.4 (1-13) years in the CRPP group and 5.4 (2-9) years in the mini-ORPP group. The average age of the patients at the time of surgery was 5.4 (1-13) years in the CRPP group and 5.4 (2-9) years in the mini-ORPP group. Based on the Gartland classification system, the CRPP group included 12 type 2 and 9 type 3 fractures, while the mini-ORPP group included 4 type 2 and 9 type 3 fractures. The average postoperative follow-up duration was 8 (3-21) months in the CRPP group and 10 (3-10) months in the mini-ORPP group. The investigated parameters were postoperative complications, radiographic evaluation, and clinical evaluation, including range of motion (ROM) and Flynn's criteria. To evaluate the deformity of the humerus, Baumann's angle and the carrying angle (CA) were calculated on anteroposterior radiographs.Although no patient showed loss of reduction, deep infection, or neurovascular complications, 1 patient in the CRPP group had a cubitus varus deformity. The average CA loss in the injured elbow compared with the CA of the contralateral side was significantly larger in the CRPP group than the mini-ORPP group. In accordance with Flynn's criteria, the results in the CRPP group were excellent in 12 patients, good in 8, and poor in 1; the results in the mini-ORPP group were excellent in 12, and good in 1.To eliminate the possibility of postoperative cubitus varus deformity, the mini-ORPP is the optimal procedure for supracondylar fracture of the humerus in children.

Figure 1

Illustrations demonstrating the 2 different operative procedures used to treat supracondylar fracture of the humerus in pediatric patients. (A) Closed reduction with percutaneous pinning. Closed reduction was performed using a reduction bar, followed by percutaneous pinning with the patient in prone or lateral position. The surgeon applied traction to the limb with elbow flexion on the traction bar while the assistant applied counter-traction to the distal humerus. Percutaneous pinning was then performed after anatomical reduction was obtained. (B) Mini-open reduction through the anterior approach with percutaneous pinning. Open reduction was performed via the anterior approach, followed by percutaneous pinning with the patient in supine position. The anterior approach was used through an incision (2.5 cm) in the anterior cubital crease. After using the surgeon's finger to remove the structures caught between fracture fragments, the surgeon applied traction to the limb with elbow extension and maintained the alignment of the fracture fragments with the left thumb while the assistant flexed the elbow of the patient. Percutaneous pinning was then performed after anatomical reduction was obtained.