Aim: To identify reasons why surgical management of displaced supracondylar fractures of the humerus in children failed

Method: A retrospective analysis of 42 patients treated at our department over a 4 year period with case note and radiological review. Data was recorded with regards to mechanism of injury, operative method and technique with radiological assessment using Bauman’s angle and the Shaft-condylar angle. Using follow up information in case notes and radiologically, surgical “failures” were identified.

Results: Overall demographics were consistent with previous studies with a median age of 6.5 years. 95% of the case notes and 75% of the X-rays were reviewed. 80% of the injuries were Gartland 3 type fractures. We noted a 9% incidence each of preoperative neurological and vascular injury and ipsilateral fracture. Median time to surgery following admission to A+E was 3.5 hours with 90% performed before midnight. Overall early fracture displacement rate was 25% with a reoperation rate of 14%. 88% of the early displacement resulted from Gartland 3 fractures treated with manipulation only. The remainder was attributable to CRIF/ORIF using a crossed lateral wiring configuration.

We noted 1 case of iatrogenic ulnar nerve injury, 2 cases of cubitus varus @ 1 year associated with medial column comminution, 2 cases of hypertrophic scar formation and 3 cases of asymptomatic cubitus valgus. No deep infection. 2 superficial infections.

Conclusion: The management of displaced supracondylar fractures can potentially be fraught with problems therefore a standardisation of surgical management should be set for each hospital.