Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience

Abstract

A retrospective review of 115 patients treated surgically for displaced supracondylar humeral fractures was conducted. All patients had a minimum of 2 years' follow-up (range 2 to 7 years). According to a modified Gartland (19) classification system, 18.3% were type II (21/115), 77.4% were type III (89/115), and 4.3% (5/115) type IV supracondylar fractures. Twelve percent (14/115) of patients presented with neurapraxias, with the radial nerve being the most commonly affected. Sixty percent (69/115) of patients were treated with a crossed K-wire configuration, while another 30% (35/115) received two lateral pins as their internal fixation. The remaining 10% (11/115) of patients were treated with a variety of "other" pin configurations, including four lateral pins, three lateral pins, one lateral and one medial pin constructs. Eighty patients were treated in the lateral position with the C-arm horizontal, while 35 were treated supine using the C-arm base as the operating table. There were 23 complications noted, with 5 children with cubitus varus, 4 children with cubitus valgus, 3 pin-tract infections requiring antibiotic therapy, 3 failed closed reductions in the operating room that required formal open reduction and internal fixation, and 2 patients experiencing pin breakage. For a subgroup of 77 patients, satisfactory clinical and radiographic data were available for the purpose of evaluating these patients with Flynn's supracondylar rating scale as well as Baumann's angle (15). Eighty-three percent had good or excellent results, 14- had fair results, and 3% had poor results. At completion of bony healing 9 children fell outside the normal range for Baumann's angle established by Williamson et al. (45). Five children were noted to have cubitus varus (Baumann's angles ranging from 83 degrees to 90 degrees) and 4 children had significant cubitus valgus (Baumann's angles ranging from 60 degrees to 63 degrees).