MANAGEMENT OF SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN BY CLOSE REDUCTION AND IMMOBILIZATION OF THE ELBOW IN EXTENSION AND SUPINATION
AbstractBackground: A Supracondylar fracture of the humerus is the most common fracture in childrenaround the elbow and is also called first decade injury. If not treated properly it may lead todisability due to elbow stiffness, and sequel of neuro-vascular injuries like Volkmann ischemiccontracture etc. This study was undertaken to determine the outcome of close reduction andimmobilization of the elbow in extension and supination in displaced supracondylar fractures ofthe humerus in children. Method: This Quasi-experimental study was conducted in theDepartment of Orthopaedics, Postgraduate Medical Institute, Lady Reading Hospital Peshawar,from January 2007 to December 2007. The inclusion criteria was Gartland Type III (completelydisplaced) supracondylar fractures of the humerus and the exclusion criteria was open or closedGartland type-III fracture associated with neurovascular injury. Close reduction under generalanaesthesia was done and the elbow was immobilized in extension by the application of 2 plasterslabs according. The follow up is based on the overall rating using the modified Flynn globalcriteria. Results: Out of 70 cases, in 56 cases (80%), reduction was acceptable; while in 14 cases(20%) it was unacceptable. Those with unacceptable reduction, 2nd attempt of close reduction weredone but only eight were successful and the other six children required open reduction and internalreduction. Those with acceptable reduction went in to union with the carrying angle ±5º of thecontra-lateral side and full range-of-motion. Excellent result were achieved in 35 cases (50%),good in 15 cases (21.43%), fair in 4 cases (5.71%) and poor in 6 (8.75%) patients. Conclusion:The extension method of close reduction and immobilisation with two slabs is safe method andgive better cosmetic results in uncomplicated type III injures as compared to the flexion method.Keywords: Supracondylar humeral fractures, Close reduction, extension method
delas Heras J, Duran D, delas Cerda J, Romanillos O,
Martinez-Miranda J, Rodriguez-Merchan EC. Supracondylar
fracture of the humerus in children. Clin Orthop Relat Res
Kasser JR, Beaty JH. Supracondylar fractures of the distal
humerus. In: Beaty JH, Kasser JR, eds. Rockwood and
Wilkin’s Fractures in children. 5th ed. Philadelphia:
Lippincott-Williams and Wilkins; 2001.p. 577–624.
Davis RT, Gorczyca JT, Pugh K. Supracondylar humerus
fractures in children. Clin Orthop 2000;376:49–55.
J Ayub Med Coll Abbottabad 2009;21(4)
Reynolds RA, Jackson H. Concept of treatment in supracondylar
humeral fractures. Injury 2005;36(Suppl 1):A51–6.
Khan MS, Sultan S, Ali MA, Khan A, Younis M.
Comparison of percutaneous pinning with casting in
supracondylar humeral fractures in children. J Ayub Med
O’Hara LJ, Barlow JW, Clarke NMP. Displaced
supracondylar fractures of the humerus in children: Audit
changes practice. J Bone Joint Surg 2000;83-B:204–10.
Umar M, D’ Sousa P. Supracondylar fractures of the humerus
in children. An analysis of different treatment modalities at
the Aga Khan University Hospital. Pak J Surg 1991;7:16–22.
Wilkins KE. The operative management of supracondylar
fractures. Orthop Clin North Am 1990;21:269–89.
Shoaib M, Hussain A, Kamran H, Ali J. Outcome of closed
reduction and casting in displaced supracondylar fractures of
the humerus in children. J Ayub Med Coll 2003;15(4):23–5.
Schoenecker P, Delgado E, Rotman M, Sicard GA, Capelli
AM. Pulseless arm in association with totally displaced
supracondylar fracture. J Orthop Trauma 1996;10:410–5.
Williamson DM, Coates CJ, Miller RK, Cole WG. Normal
characteristics of the Baumann (humero-capitellar) angle and
aid in assessment of supracondylar fractures. J Pediatr Orthop
Chen RS, Liu CB, Lin XS, Feng XM, Zhu JM, Ye FQ.
Supracondylar extension fracture of the humerus in children.
Manipulative reduction, immobilization and fixation using a
U-shaped plaster slab with the elbow in full extension. J
Bone and Joint Surg Br 2001;83:883–7.
El-Sharkawi H, Fattah HA. Treatment of displaced
supracondylar humerus fracture in full extension and
supination. J Bone Joint Surg Br 1965;47:273–9.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.