Type III Supracondylar Fractures of the Humerus in Children – Straight-Arm Treatment

摘要

Introduction: Gartland type III supracondylar fractures are a common injury in children. We present a method of manipulative reduction, immobilisation and fixation using a Plaster of Paris with the elbow in full extension (straight-arm).Method: Retrospective study looking at all patients with Gartland type III supracondylar fractures in Wellington Public Hospital during the period of February 1999 until March 2007, under the care of the senior author. The seven patients had been treated in the straight-arm technique with the outcomes reviewed in this study.Result: All parents were satisfied with the results. Using the Flynn criteria6, six patients achieved excellent results and one good when looking at the carrying angle. When looking at the range of motion four patients had good results, one fair and two poor.Conclusion: Straight-arm treatment of Gartland type III supracondylar fractures appears to be a non-invasive and safe alternative to K-wire fixation. Introduction Supracondylar fracture of the humerus occurs at the metaphyseal bone, proximal to the elbow joint, and does not involve the growth plate.1 The extension type of supracondylar fracture of the humerus is the most common, occurring in 95% of cases.2 The most frequently used methods of treatment are closed reduction and application of a cast, traction (skeletal or skin), closed reduction and percutaneous Kirschner-wire (K-wire) fixation, and open reduction with internal fixation3. Management of the displaced fracture is fraught with problems, including Volkmann’s ischaemic contracture, cubitus varus deformity, and difficulty obtaining and maintaining reduction.34Supracondylar fractures of the humerus are usually classified according to the system described by Gartland.5 Type I fractures are not displaced. Type II fractures are partially displaced, but some contact remains between the proximal and the distal fragment. Type III fractures are completely displaced.A method of manipulative reduction, immobilisation and fixation using a Plaster of Paris with the elbow in full extension for type III supracondylar fractures of the humerus in children is presented here. A study by Chen et al.2 presented a similar method of reduction and immobilisation with promising results. Method A retrospective study was carried out. The population consisted of all patients who had Gartland type III supracondylar fractures who attended Wellington Public Hospital during the period of February 1999 until March 2007 under the care of the senior author. A hospital patient database was used to access potential patients. The search criteria were as follows; no date criteria, limited to those cases in which the senior author was directly involved in the case, limited to those cases in which the patient was 16 years of age or under at time of surgery. The search led to a list of 98 patients. The notes of these patients were obtained through the hospital medical records and read through to determine if the patient had a Gartland type III fracture. There were seven patients with this type of fracture.The mean age of patients at the time of fracture was six years and two months. The range was between 4 years 3 months and 8 years 5 months. All patients who presented with a Gartland type III fracture during the study period were treated with the straight arm technique.Once the diagnosis of Gartland type III fracture was made with clinical and radiological data, the patient was taken to the operating theatre (OT). A well moulded above elbow Plaster of Paris cast was applied with the elbow in full extension. The carrying angle was matched with the opposite unaffected elbow. An anterior-posterior (AP) radiograph was taken in the OT to ensure that Bauman’s angle was less than 80 degrees. The patient was discharged once comfortable and seen again in one week’s time. At this time an AP radiograph was ordered to check Bauman’s angle. No lateral radiograph was done as this did not contribute to the managemen