Audit of Operative Management of Displaced Supracondylar Humeral Fractures in Children

Abstract

Background: Supracondylar Humeral fractures (SCHF) constitute one of commonest fractures around elbow in children. Management of these fractures in very challenging. Majority of displaced supracondylar fractures are treated by closed manipulation and pinning. We did a retrospective study to analyze the functional outcome identify factors predisposing to complications. Materials and Methods: Retrospective study of 40 patients with displaced supracondylar humerus fractures operated in Nizwa Hospital and who met our inclusion criteria were included in our study. All patients were treated with closed reduction and percutaneous pinning. We reviewed their case file records to record classification, operation notes, follow up and any complications noted. Results: 28(70%) patients were male and 12(30%) female. The time elapsed from onset of trauma to surgery was on average 8.3 hours. The mean age of patients was 6.5 years with age range of 02-12 years. In 22(55%) patients fractures were fixed with cross pins and in 18(45%) patients with two lateral pins. The major cause of fractures was fall in 32(80%) cases followed by motor vehicle accidents in 08 (20%) cases. Superficial pin tract infection was recorded in 04(10%) Iatrogenic ulnar nerve injury were noted in 03(13.6%) patients with cross pinning. Loss of reduction in 01(2.5%) case due to pin migration was recorded. Final outcome assessment as per Flynn criteria was Excellent in 68% (mediolateral) 61% in lateral pinning group patients, Good in 22.8% (mediolateral) 22.3% in lateral pinning group patients, Fair in 9% (mediolateral) 11% in lateral pinning group patients, Poor 0% (mediolateral) 5.6% in lateral pinning group patients Conclusion: Percutaneous Krischner wire fixation for displaced Supracondylar Humeral fractures in children is safe method with predictable outcome, however cross pinning is associated with more risk of iatrogenic ulnar nerve injury.