Retrospective Analysis Of The Treatment Of Gartland Type-â…¢ Supracondylar Fractures Of Humerus In Children

Objective:We performed a retrospective analysis to compare the clinical results of open reduction and K-wire fixation using different approach with that of closed reduction and external fixation for the treatment of Gartland type-Ⅲ supracondylar humerus fractures in a paediatric population.Methods:From2008March to2012March, we retrospectively evaluated62children with Gartland type-Ⅲ supracondylar humerus fractures (36boys and26girls) with a mean age at presentation of8.3years (range,3to14y).54cases received open reduction and K-wire fixation, including triceps-sparing approach (Group A) for26cases and triceps tongue-shaped flap approach (Group B) for28cases. Eight cases of patients (Group C) underwent closed reduction and plaster external fixation. The average follow-up period was7.3months (range,6to10m). The differences of age, sex, fracture type and location, fracture healing time, recovery time of elbow joint function and humeroulnar angle were compared among the groups.The functional results were assessed according to Flynn’s criteria. Results:There were no significant differences among the groups regarding base-line characteristics such as age, sex, fracture type and location. The average fracture healing time of Group C (5.63weeks) was lower than that of Group A (7.31weeks) and Group B (7.46weeks). The average recovery time of elbow joint function in Group C is12.63weeks longer than in Group A (9.08weeks) and Group B (10.46weeks). According to Flynn’s criteria, the rate of satisfactory functional outcomes in Group A, Group B and Group C were88.46%,78.57%and25.00%.The rate of satisfactory functional outcome of Group A and Group B were superior to that of Group C, and Group A was superior to Group B. The excellent rate of humeroulnar angle in Group A, Group B and Group C were73.08%,89.29%and25.00%.The excellent rate of humeroulnar angle in Group A and Group B were superior to that in Group C, and Group B was superior to Group A. There were no cases of Volkmann ischemic contracture, myositis ossificans, elbow joint stiffness and iatrogenic nerve damage. Cubitus varus deformity was found in seven cases.Conclusion:Open reduction with K-wire fixation and Closed reduction with external fixation by plaster were effective method for Gartland type-Ⅲ supracondylar fracture of humerus in children. Open reduction and K-wire fixation confers superior functional outcomes for Gartland type-Ⅲ supracondylar fractures of humerus in children than closed reduction and plaster external fixation, for whom the triceps-sparing approach may be a better choice than triceps tongue-shaped flap approach regarded as the early recovery of elbow function.