Short-Term Management Outcomes of Supracondylar Fractures of the Humerus and Their Associated Factors in Children Managed at Mulago National Referral Hospital

Abstract

Purpose: Supracondylar fractures (SCF) of the humerus is one of the commonest global health concerns among children and need a rigorous management process to obtain satisfactory outcomes. It is of paramount importance to use systematic guidelines to aid abate bad fracture outcomes. The study primarily sought to determine the functional and radiological management outcomes of SCF of the humerus in children at Mulago National Referral Hospital (MNRH) and associated factors to the outcomes.

Methods: We conducted a hospital-based, cross-sectional study among children managed for SCF of the humerus at MNRH. Using Flynn's criteria, current flexion and extension at the elbow joints, humeroulnar angle and the neurology were assessed and compared to the contralateral limb to get the functional outcomes. The pre-management digital radiographs of the elbow joint were compared with the current radiographs to assess radiological outcomes. Bivariate and multivariate analyses were used to determine the associated factors.

Results: Of the 77 children, 46 (60%) were male with a mean age of 7.86±2.30 years. Gartland type I fracture constituted 55.8% (43), type II was 29.9% (23) and type III was 14.3% (11). About 88.3% of the patients were managed non-operatively and 11.7% were managed operatively. The overall satisfactory functional outcome was 46.7%, while 81.8% of the patients had a satisfactory radiological outcome at 6 months after the intervention. Delay in seeking treatment, type 1 fracture, and prolonged duration of immobilization were significantly associated with unsatisfactory functional management outcome. Type II fracture and prolonged duration of immobilization were significantly associated with unsatisfactory radiological management of SCF of the humerus.

Conclusion: The short-term functional outcome was unsatisfactory, while a satisfactory radiological outcome was found in most of the patients. Duration of immobilization, type of fracture, and seeking late medical care had a negative impact on the outcome of these fractures.

Keywords: children; fracture; management; outcome; supracondylar.

Figure 1

Histogram showing age distribution. The Mean±SD age was 7.86±2.30 years. Most patients, 63 (81.82%) lied between 5 and 9 years of age while few, 14 (18.18%) were in the age category of 10–14 years old as per the study age group. The youngest participants were 5 years old, while the oldest was 14 years old. The above histogram shows a positive tailed distribution because there were more participants with age above the mean age.

Figure 2

Pie-chart showing proportion of study participants according to type of fracture. Majority of the patients [43 (55.84%)] had Type I fracture while few of the patients [23 (29.87%)] had Type II fracture and very few [11 (14.29%)] had Type III fracture. The pie-chart shows the proportion of study participants according to the fracture type.

Figure 3

Pie-chart showing time from injury to presentation. More than half of the patients [45 (58.44%)] presented for treatment after 72 hours (≥3 days) with few patients [21 (27.27%)] who presented for treatment within 24–48 hours (1–2 days) and very few patients [11 (14.29%)] presented for treatment on the same day of injury.

Figure 4

Bar graph showing method of management. From the graph, more than half of the patients [68 (88.31%)] were managed through closed reduction and casting followed by 7 (9.09%) were managed through open reduction and cross pinning and only 2 (2.60%) were managed through closed reduction and percutaneous pinning.