O2201 DISPLACED SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN – A REVIEW OF FOUR DIFFERENT METHODS OF MANAGEMENT

Abstract

Aim: To evaluate the outcome of various methods of treatment of displaced supracondylar fractures of the humerus in children, by clinical & radiological means. Material and Method: 96 patients with displaced supra-condylar fractures of the humerus admitted between January 1990 & September 1998 were recalled to clinic for a clinical & radiological assessment. The results of treatment by 4 different methods were assessed & compared. The mean length of follow up study was 4.1 years (range 1 to 8 years). Results: By Flynnñs criteria, 32 of the 41 patients treated with percutaneous kirschner wire þxation had an excellent result (78%). This was followed by (72.7%) with open reduction & internal þxation & (71.4%) with skeletal traction. Closed reduction & application of an above elbow cast had signiþcantly lower excellent results (51.4%) & higher percentage of complications including compartment syndrome & cubitus varus. The smallest mean change in carrying angle was in the percutaneous kirschner wire þxation group with the highest incidence of cubitus varus in the closed reduction & cast group (6/37 patients-16.2%). Conclusion: Treatment with a cast is inappropriate in the management of a displaced supracondylar fracture of the humerus as either the initial or the subsequent method of treatment. Crossed medial & lateral percutaneous K- wire þxation is advocated as the treatment of choice for majority of the displaced fractures keeping 2 lateral kirschner wires for the swollen elbow in which the medial epicondyle is barely palpable. Principal advantages would be fewer sequelae, more stable þxation & better anatomical results. Traction still has its indications. ORIF should be reserved for open fractures, irreducible fractures & fractures needing vascular exploration.