Open Surgical Treatment of Extension Type Displaced Supracondylar Fractures of the Humerus in Children Through Combined Medial and Lateral Approaches

摘要

Supracondylar fracture of the humerus is the most common fracture in the elbow region in children. Many methods have been proposed to treat Gartland type III supracondylar fractures of the humerus in children: one of them is open reduction and internal fixation with Kirschner wires through combined medial and lateral approaches. From Jan 1995 to Jan 2002, 60 children with extension type, Gartland type III supracondylar fracture of humerus underwent surgery using open reduction internal fixation method through combined medial and lateral approaches in Shohada and Imam Khomeini hospitals, Tabriz, Iran. The cases suffered from either of the following: severely displaced fracture, open fracture, primary neurovascular complication or unsuccessful closed reduction. Children were followed-up for a mean time of 5 years. Sixty children (63% boys, 37% girls), mean age 6.5 years (3-9 years) were followed up. Pin-tract infection occurred in 2 patients and was successfully treated with pin removal and antibiotics. Three cases of iatrogenic nerve injury (2 median and 1 ulnar) were reported but patients gradually regained full neurological function by a mean of 2.5 months. All fractures healed within 6-8 weeks. No compartment syndrome, non-union, mal-union, myositis ossificans, deformities or vascular deficits were noted. Only 10% of patients had a reduction of the carrying angle (less than 20?). Six (10%) patients lost less than 20? of movement in flexion of the elbow. Ninety percent of children had excellent results and the others had good results according to the criteria developed by Innocenti. Operative reduction and pin fixation through combined medial and lateral approaches is one of the best methods to treat Gartland type III fractures.