Treatment of Supra- and Percondylar Fractures of the Humerus in Children: Consequences for Management from a Retrospective Analysis of 137 Cases

Abstract

In a period of 5 years 137 children with supra- and percondylar fractures of the humerus were treated at the Department of Pediatric Surgery (Virchow-Klinikum) of the Free University of Berlin/Germany.
86 of the total cohort (62.8 %) were followed up and the outcome was related to the initial therapeutic strategies.
Impaired movement was found in 21 % of the follow-up cohort, with 14 % showing impaired flexion and 7 % impaired extension. Half of the cases with impaired extension had a reduction of movement below 10 degrees being unnoticed by the children. More pronounced movement deficit was associated with higher age, higher degree of dislocation and increased number of repositions.
The relation between the degree of dislocation and the number of repeated reductions of fractures with the higher degree of dislocation was remarkable. The worst outcome had patients with three repositions: 60 % had impaired movement and 40 % had weight-dependent pain.
Secondary dislocations of conservative treated Baumann III fractures were so frequent that a primary Kirschner-wire-fixation is recommended. Movement-deficit and weight-dependent pain in the follow-up cohort were independent from the initial degree of dislocation; the functional results of the surgical treatment (open reposition and wire-fixation) were superior to those of the non-invasive strategies. The best outcome was achieved in those cases were a definitive primary treatment was possible with anatomically reduction.
Thus these results lead to recommendations for a primary Kirschner-wire-fixation as well as primary surgical treatment to achieve a gentle and anatomically repositioning of supra- and percondylar fractures.

Key words

Supracondylar fractures - percondylar fractures - child - therapy - operative - conservative

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