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Abstract
Supracondylar fractures of the humerus in children are common and account for 60% of all fractures of the elbow region. More than 97% of all supracondylar fractures are displaced in extension and only 3% of the fractures are displaced in flexion.
Supracondylar fractures are usually classified according to the amount of displacement of the two fragments. This classification was originally proposed by Gartland and is still the most useful. Type I is a non-displaced fracture, type II is an angulated fracture with and intact posterior cortex and type III is completely displaced fractures with all continuity of the two fragments lost.
Treatment of elbow fractures in children remained a great challenge for surgeons since Hippocrates. Proper training is needed to adopt recent advances by young surgeons to deal with these challenge.
There are various treatment modalities for the management of supracondylar fracture of the humerus in children including closed reduction and casting, open reduction and internal fixation and closed reduction with percutaneous pinning.
If closed reduction and casting is chosen, the cast should be applied with the elbow at greater than 120º flexion to maintain reduction. There is a great chance for vascular affection and loss of reduction. So, this method is reserved for type I fractures.
Displaced supracondylar fractures (types II and III) should be treated with closed reduction and percutaneous pinning in controlled environment i.e. during day when trained orthopedic surgeon, assistant and image intensifier with technician are available, either two lateral or are lateral and one medial pin may be used and both should penetrate the far cortex. Crossed pins provide better stabilization than two lateral pins.
Open reduction and internal fixation is reserved for displaced fracture not reduced by closed means, vascular injury needs exploration of the brachial artery and compound fractures.
Closed reduction and percutaneous pinning as compared to cast immobilization is safe in terms of negligible chances of compartment syndrome and loss of reduction with cubitus varus deformity.
Closed reduction and percutaneous as compared to open reduction and internal fixation has less chances of elbow stiffness and is cost effective in terms of no use of suture material, prolonged prophylactic antibiotics and short hospital stay. So, closed reduction and crossed percutaneous pinning in displaced supracondylar fracture of the humerus is safe, time and cost effective and gives stable fixation with excellent results.