Open Versus Percutaneous Cross K-Wires Fixation for Displaced Supracondylar Fractures of the Humerus in Children
Background: Supracondylar fractures of the humerus are common injuries in
children. It represents 17% of all childhood fractures. The peak age of fracture is 5
to 7 years. The vast majority of supracondylar fractures of the humerus are of extension
type (97%). Flexion-type injuries also occur but it is rare (3%).
Objective: To compare the outcome results of surgical closed reduction to open reduction
with cross-pinning fixation in Gartland type II and III extensions type supracondylar
humeral fracture in children.
Methods: During the period between February 2014 and March 2016, we made a caseseries
study of (20) patients collected from the emergency unit of Al-Kindy Teaching
Hospital, suffered from Gartland type II and III supracondylar humeral fracture extension
type. They were managed surgically with either closed reduction (10 children) or open
reduction (10 children), both with cross pinning fixation. The study includes (13) boys and
(7) girls with a mean age of (6) years. We chose two surgical means of fixation; open and
percutaneous randomly and we tried to compare between the two.
Results: All the (20) patients were followed-up, clinically and radiographically evaluated
pre-surgery, post-surgery and finally (6) months after surgery. Radiologically, after surgery
in both groups anterior humeral lines cross the capitellum in all patients. At the same time
all Baumann’s angles were in the normal range, and in comparison with contralateral side
all differences less than 5º except one case treated by percutaneous method it was about
6º difference. At the last follow-up (after 6 months), patients were assessed functionally
according to Flynn’s criteria. Range of motion in flexion, extension of the elbow was the
functional parameter in our study in addition to carrying angle as graded by the Flynn’s
grading system. In open surgery group: we obtained an outcome of excellent results in (8)
patients (80%), good results in (1) patient (10%) and fair in (1) patient (10%). In
percutaneous surgery group: we obtained an outcome of excellent results in (8) patients
(80%), good results in (2) patients (20%). The results in both groups were satisfactory and
we have no poor results in both.
Conclusions: In spite of approximated results, a long list of advantages make
percutaneous method as an effective modality of surgical treatment in comparison with
open method. Closed reduction with percutaneous pinning is believed to represent a
reliable method of managing displaced supracondylar fractures in children, reduces
hospitalizations, physical therapy, with less complications and faster return to daily
activities of children. Giving good and excellent results.
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