SURGICAL TREATMENT FOR DISPLACED SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN USING AN APPROACH BASED ON THE VASCULAR ANATOMY OF TRICEPS BRACHII.

Abstract

Introduction: It may not be possible to obtain anatomical reduction of displaced supracondylar fractures in children by closed manipulation. We have found difficulties performing open reduction using the described surgical approaches. We report an approach based on studies of the vascular anatomy of triceps, which provides a wide exposure facilitating surgery.

Material And Methods: Between 2002 and 2004 we performed open reduction and internal fixation on 12 children (8 girls, 4 boys: mean age 6).

Our vascular injection studies indicate that the blood supply to triceps brachii is proximally based. We used a posterior approach identifying the ulnar nerve. We mobilised lateral triceps and anconeus in continuity preserving the vascularity and separated the components of distal triceps through an intermuscular septum. The fractures were reduced and fixed using K wires.

Results: The fractures healed in the anatomical position in each child and all 12 demonstrated a full range of elbow movements within 6–8 weeks of K wire removal. We observed no complications.

Discussion: Although closed reduction and percutaneous K wire fixation remains the treatment of choice for displaced supracondylar humeral fractures, anatomical reduction must be achieved ideally and residual rotation of the fracture fragments avoided. We have found that this surgical approach has reduced our reluctance to proceed to surgical treatment of these difficult fractures and consequently a tendency to accept sub optimal reduction.

Conclusion: A surgical approach based on the vascular anatomy of triceps can be used to provide a wide, symmetrical and safe exposure facilitating open reduction and internal fixation of supracondylar fractures of the humerus in children whilst avoiding complications including residual elbow stiffness.