Purpose: The treatment algorithm for supracondylar humerus fractures in children under age seven is well-established. However, the best treatment option for these fractures in older children (8–14 year olds) is debated. The purpose of this study was to assess the efficacy of closed versus open fixation methods of this fracture type in older children. We hypothesize that closed reduction and percutaneous pinning (CRPP) is as effective as open reduction and internal fixation (ORIF).

Method: A retrospective chart review was completed of all patients 8–14 years old treated for supracondylar humerus fractures at one centre from 2000–2007. IRB approval was obtained for this study. Demographics, treatment methods, pre- and post-operative complications, functional and radiographic outcomes were reviewed. Values are reported as mean ± standard deviation.

Results: Seventy-eight eligible patients were identified: 60 (76.9%) were treated with CRPP, and 18 (23.1%) were treated with ORIF. Demographics and fracture characteristics were similar between the CRPP and ORIF groups, although patients treated with ORIF were older (p< 0.001) and weighed more (p< 0.001). The ORIF group had higher post-operative complication rates (p=0.016). Five patients treated with CRPP required additional surgery (3 underwent ORIF; 2 underwent repeat CRPP) compared with none in the ORIF group. Children treated with ORIF had greater limitations on active flexion (99.7o ± 18.2 ORIF, 140.5o ± 23.5 CRPP, p< 0.001) and active extension (34.3o ± 19.0 ORIF, 11.9o ± 21.2 CRPP, p< 0.001) at first follow-up. Limitations in active flexion persisted in the ORIF group, but not in the CRPP group, at time of last follow-up (120o ± 14.8 versus 150.4o ± 17.8, p< 0.001). There were no group differences in active extension at last follow-up (p=0.093). On radiographs, significant differences between the groups existed for Bauman’s angles (15.5o ± 5.5 ORIF, 19.3o ± 4.9 CRPP, p=0.013) and carrying angle (12.4o ± 5.7 ORIF, 16.6o ± 5.4 CRPP, p=0.008). Radiographic union was achieved in all cases.

Conclusion: Open and closed surgical fixation are both acceptable treatment options for supracondylar humerus fracture in older children. While ORIF appears to result in reduced range of motion, no further operations were required for fracture alignment in this group.

Purpose: Femur fractures in children have a significant impact on families and the hospital system in Canada. There are several methods for treating femur fractures in children. The purpose of this study was to determine which of two techniques: Flexible Femoral Nailing (FFN) or Trochanteric Antegrade Nail (TAN), are the most safe and efficacious.

Method: Hospital charts for all paediatric femur fracture patients between 1984 and 2006 treated with either FFN or TAN were reviewed. Demographic, clinical, radiographic and hospital stay data were collected and analyzed.

Results: Ninety-seven children (100 fractures) were reviewed. The average age of patients was 11.9 years (SD = 4.4). Fifty-two fractures were treated with FFN and 48 fractures were treated with TAN. No serious complications were encountered in either group, including AVN. Minor complications in the FFN group included three patients with mal-alignment, and one with shortening of the limb. Two patients in the TAN group had shortening of the fractured limb. No radiographic differences were noted. The median length of stay for patients treated with FFN was 3 days (IQR = 2) and for patients treated with TAN was 3 days (IQR = 2). Overall, there were no significant differences in the clinical findings (including complications), radiographic evaluations, or length of stay between FFN and TAN cohorts. The only significant difference between the groups was length of surgical time (p value < 0.001).

Conclusion: TAN is as safe and efficacious a treatment as FFN but requires addition operating room time, and hence hospital resources.