The Clinical Efficacy Of Open Reduction And Internal Fixation With K-wires For Gartland-Ⅲ Neglected Supracondylar Humeral Fractures In Children

Objective:To investigate the clinical efficacy of open reduction and internal fixation(ORIF)with K-wires for Gartland Ⅲ neglec ted supracondylar fracture.Methods:From June 2012 to January 2017,forty-nine children with Gartland Ⅲ neglected supracondylar humeral fracture were revi ewed retrospectively.Thirty-five males and 14 females were include d in present study,with an average age of 6.1 years(3.4~11.5 year s).The duration from initial trauma to operation were ranged from22 days to 60 days(average 29.8 days).There were 5 cases of rad ial nerve injury,1 case of median nerve injury,and 1 case of Volk mann ischemic contracture.Six patients with nerve injury underwent neurological exploration and release.In one patient,nerve partial f racture was found during operation and nerve repair was performed.All patients underwent open reduction and internal fixation with K-wires.At the final follow-up,the fracture healing and complication s were observed.Results were assessed with Flynn’s criteria.The h umerus length and transverse diameter of humeral condylar between the healthy limb and the suffered one were compared to evaluate t he humerus growth.Results:All patients were received interval followed-up,and th e average followed-up time was 12.5 months(from 6 months to 24months).All fractures were healed.Six patients with the symptoms of nerve injury had been basically restored after 2 months through nerve exploration and postoperative neurotrophic drug treatment.O ne patient had superficial skin infections at the incision.Six patient s(12 %)developed cubitus varus deformity.At the final follow-up,the clinical and radiographic outcomes were assessed via Flynn’s c riteria,the outcome were excellent in 37 patients,good in 5,fair i n 1 and poor in 6 patients,with an excellence rate of 86%.There was no statistical difference in the humerus length[(189.3±27.8)m m vs.(190.6±28.8)mm] and transverse diameter of humeral condy lar [(29.5±3.5)mm vs.(29.7±3.6)mm](P>0.05)between the healthy limb and the suffered one,respectively.Conclusion:Open reduction and internal fixation with K-wires is an effective and promising way in the treatment of Gartland typeⅢ neglected supracondylar humeral fracture.Fracture reduction,function of elbow joint and lower incidence of cubitus varus deformit y can be achieved.Moreover,the development of the humerus coul d not be affected.