To evaluate short term results of open reduction and internal fixation after failed close reduction in Gartland Type III Supracondylar fracture of humerus in our institution.
Patients and Methods
This prospective study was conducted at the Orthopedic Department of Khyber Teaching Hospital, Peshawar from January, 2008 to March, 2009. Seventy-five patients of type-III supracondylar fracture of humerus were included in the study. Informed consent was obtained from all patients. Under general anesthesia, closed reduction was attempted first. After failure of closed reduction, an open reduction and internal fixation with cross K-wires was performed. Fortnightly follow up was carried out for two months then monthly for six months. The clinical outcome was assessed using Flynn criteria
Out of 75 patients, 47 were male and 28 were female. Left side was involved in 52 patients and right side in 23. Mean age was 6.7 years with age range from 3 to 12 years. Excellent or good results were obtained in 70 (93.3%) patients and fair or poor in 5 (6.7%).
We conclude that these fractures need to be managed aggressively and open reduction and internal fixation of severely displaced supracondylar fractures of the humerus is a safe option when a satisfactory reduction cannot be obtained by 2-3 attempts on closed method. (Rawal Med J 2010;35: ).
Supracondylar fracture, open reduction, internal fixation, close reduction
Supracondylar fracture (SF) of the humerus is the most common fracture around the elbow in children and represents approximately 3% of all fractures in children.1,2 These fractures are seen in the first decade of life especially between ages 5 and 8 years.3,4 SF of humerus are caused by fall on out stretched hand and is divided into two types, extension type and flexion type.5 97.7% of the fractures are extension type and 2.2% are flexion type.3 Extension type are further classified as describe by Gartland according to the degree of displacement of the distal fragment.2,6 Type I is undisplaced fracture, type II is displaced with intact posterior cortex, and type III is completely displaced with no contact between the fragments (Fig 1).7
The treatment modalities include side arm traction, overhead skeletal fraction, closed reduction and casting with or without percutaneous pinning and open reduction and internal fixation.8,9 Type III SF of humeral are usually treated by closed reduction and percutaneous K-Wires fixation, but open reduction and fixation is performed if an adequate reduction cannot be obtained by closed manipulation.10-13 Close manipulations should be avoided in displaced type-III postrolateral SF with neurovascular deficit as the neurovascular bundle may be trapped in the fracture site.4,14 The indications for open reduction and internal fixation (ORIF) are failed closed reduction, open fractures that needs debridement and irrigation, and fractures complicated b
Key words: Supracondylar fracture, open reduction, internal fixation, close reduction