To compare outcome between the medial and posterior approaches for the surgical treatment of supracondy-lar fractures when performed by two experienced surgeons.

A retrospective analysis of 45 children, mean age of 5.5 years (2.5-11 years), treated for closed Wilkins IIB/III supracondylar fractures without vascular deficit between January 1999 and December 2004. Twenty-one and twenty-four children were treated using the medial and posterior approaches respectively. The medial approach is quicker but technically demanding. The posterior approach is easier but cuts through the intact posterior structures. In both groups the fracture was stabilised using crossed K-wires and the arm was immobilised in an above elbow backslab for 3 to 4 weeks. Follow-up was at 3 to 4 weeks, 3, 6, and 9 months, and at 1 year. The results were assessed clinically using Flynn’s classification and radiologically using the metaphyseal-diaphyseal and humerocapitellar angles.

There was no post-operative infection or redisplace-ment. Clinically, the medial approach gave 18 excellent, 2 good, and one fair result, and the posterior approach gave 21 excellent, 2 good, and one fair result (P> 0.50). Radiologically, the medial approach gave 18 excellent and 3 good results, and the posterior approach gave 20 excellent and 4 good results (P> 0.50).

We found no significant difference in outcome between the two approaches, both giving mostly excellent long term results. Each approach has its known merits and drawbacks. This type of fracture needs an experienced surgeon comfortable with his preferred approach.