Displaced Type II Extension Supracondylar Humerus Fractures

Orthopedic versus surgical treatment of Gartland type II supracondylar humerus fracture in children

“…These findings compare well or are even better than those reported by Camus et al [3]; despite the fact that their overall Baumann's angle value is similar to ours, the percentage of patients in their study falling outside the normal ranges for Baumann's angle and carrying angle (cubitus varus) was much higher (47%) than ours. Loss of reduction is one of the most important and frequent complications described for supracondylar humeral fractures treated nonoperatively [11] and ranges from 20 to 28% depending on the series [10,12,15]. In contrast, loss of reduction was not reported in our patients.…”

“…The treatment of type II fractures remains controversial. Whereas most authors prefer surgical treatment [3,8,11,12], others prefer orthopedic treatment [10,14,15]. However, there are few studies that compare the clinical and radiographic outcome with orthopedic or surgical treatment [12,15,16].…”

“…In addition, the risk of compartment syndrome, malunion, loss of reduction, stiffness, and residual deformities (cubitus varus or cubitus valgus) is increased with orthopedic treatment of these fractures [3,[11][12][13]. In contrast, other authors defend orthopedic treatment on the basis that closed reduction and casting yield good functional and radiographic results and do not lead to anesthetic complications and surgical complications such as iatrogenic neurovascular injury (ulnar nerve), pin-site, or bone infections and scars [10,[14][15][16]. It has been reported that closed reduction and pinning of all Gartland type II fractures would have resulted in 77% of patients having an unnecessary procedure, thus suggesting that orthopedic treatment should be used as the initial treatment of these fractures [14].…”

“…Currently, the most widely accepted treatment criteria recommend nonoperative treatment for type I supracondylar humeral fractures and surgical treatment for types III and IV [3,8,10]. Controversy exists about the optimal treatment for type II fractures.…”

Supracondylar Fracture in Children Treated by Closed Reduction and Internal Fixation With K-Wires

“…9 DEVANANI AS (2005) recommends gradual reduction of supracondylar fractures which presents late, followed by correction of unacceptable deformity by an osteotomy. 10 CHEN W (2010) conducted 203 cases of retrospective analysis of complications of supracondylar fractures of humerus in children and concluded that early reduction is the key for prevention of further vascular injury, nerve injury and osteofascial compartment syndrome.…”