Abstract
Purpose: Management of supracondylar fractures of the humerus becomes a controversial issue when there is major displacement. The risk of vessel and nerve injury is very high, making reduction and fixation particularly difficult.
Material and methods: We conducted a retrospective analysis of 100 supracondylar fractures managed over a ten year period. All of these fractures were in extension and exhibited a bone gap. We analysed early and late complications.
Results and discussion: Mean age at trauma was 6.5 years, with six boys for four girls. The left side was involved in 69% of the cases. Falls were the predominant cause (48%).
Thirty-two percent of fractures were complicated initially: nerve injury (n=17), vascular injury (n=12) (including three cases with nerve and vascular injury), open fractures (n=7). The medial nerve was injured in most cases (n=12). Ulnar palsy was noted in four patients and radial palsy in one. Vessel injury led to abolition of the radial pulse in eight patients and the ulnar pulse in one; all resolved after reduction. Ischaemia of the hand was noted in two cases before reduction of the fracture but vascular surgery was not required.
Most of the fixations were achieved with cross pinning (percutaneous insertion in 47 patients and open surgery in 13). Despite minimal medial skin incision, ulnar nerve deficiency was observed after surgery in seven cases; four were rapidly regressive and three required surgical exploration with neurolysis. Six revision procedures were required for secondary displacement (10%).
The 26 Judet fixations led to ten secondary displacements requiring surgical revision for cross pinning. Four cases of postoperative ulnar nerve deficiency were noted: reoperation to release the nerve pinched in the fracture was required for only one patient.
The Blount technique was used in nine cases with four secondary displacements, including one related to two sites of nerve impingement.
Five cases of superficial pin tract infection which resolved rapidly and two cases of deep infection were noted in the early postoperative period.
Formation of a varus ulnar callus was noted in five cases: two required secondary surgery for correction.
Conclusion: Our results point out the high rate of vessel and nerve complications related to these supracondylar fractures of the humerus with displacement. We recommend cross pinning which is mechanically superior and which does not compromise the neurological result if a minimal medial incision is used.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
