Supracondylar fracture of the humerus in childhood

Česká verzia

Authors: P. Havránek; T. Pešl; J. Hendrych; M. Kučerová
Authors place of work: Klinika dětské chirurgie a traumatologie 3. LF Univerzity Karlovy a Thomayerovy nemocnice
Published in the journal: Rozhl. Chir., 2018, roč. 97, č. 3, s. 122-127.
Category: Původní práce

Summary

Introduction:
Supracondylar fracture of the humerus can be considered the most serious fracture in childhood. Problems with its diagnostics and treatment as well as its complications and sequels have not been fully solved yet. That is evidenced by a large amount of articles with frequently inconsistent conclusions. The aim is to evaluate contemporary diagnostic and therapeutic approach based on our own clinical experience.

Methods:
A total of 2847 children with skeletal injury were treated by the authors during the year 2016. Two hundred and seventy-five of them suffered from supracondylar fracture of the humerus (9.66%). All the fractures were classified using the authors’ own scheme. Fragment displacement was evaluated according to a three-degree scale.

Results:
Ninety-three of 275 supracondylar fractures were treated non-operatively (33.8%) and 182 by surgery (66.2%). Closed reduction and percutaneous pinning by K-wires under X-ray (C-arm) control was the method of choice. Crossed K-wires were used in 90% and in 9.9% two K-wires were inserted laterally only. In 70.9%, pins were buried and in 29.1 % unburied pins were used. Neurological lesions were noted in 13.5%. A total of 82.9% of children were healed without any sequels.

Conclusion:
Supracondylar fracture of the humerus in children should be managed in pediatric trauma centers, especially in more complicated cases. Fracture classification needs to be more detailed than those commonly used so far. Closed reduction and percutaneous pinning is the method of choice. Acute neurological and/or vascular complications can be managed in an overwhelming majority of cases, after fragment fixation, non-surgically.

Key words:
supracondylar fracture − humerus, miniinvasive osteosynthesis − neural lesion − compartment syndrome

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