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Clinic of Pediatric Surgery and Orthopedics
Clinical Center Niš
Bul. Zorana Đinđića 48
18000 Niš, Serbia
SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN
Nikola Bojović, Zoran Marjanović, Dragoljub Živanović, Nina Đorđević, Miroslav
Stojanović, Goran Janković and Nikola Vacić
Clinic of Pediatric Surgery and Orthopedics, Clinical Center Niš, Niš, Serbia
Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%). They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand.
We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification). At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of „К“ wires.
None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3–4 weeks). Bauman’s angle, carrying angle and functional factor were measured postoperatively.
Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments). Acta Medica Medianae 2012;51(3):5-12.
Key words: supracondylar fracture, elbow, reposition, fixation