Does open reduction and pinning affect outcome in severely displaced supracondylar humeral fractures in children? A systematic review

Abstract

Supracondylar fracture of the humerus is the second most common fracture in children (16.6%) and the most common elbow fracture. These fractures are classified using the modified Gartland classification. Type III and type IV are considered to be totally displaced. A totally displaced fracture is one of the most difficult fractures to manage and may lead to proceeding to open procedures to achieve acceptable reductions. Many surgeons are concerned about its outcome compared to closed procedures. We therefore performed a systematic review of the literature to investigate the existing evidence regarding functional and radiological outcomes as well as postsurgical complications of primary open compared to primary closed reduction.

Medial mini-open versus percutaneous pin fixation for type 3 supracondylar fractures in children

“…Biomechanical studies suggest that medial and lateral crossed K-wire fixation is the most stable. [13,14] Some authors assert the importance of an additional medial K-wire to prevent reduction loss. [15,16] Incidence of iatrogenic nerve injury of 14.3% was recently reported in surgically treated cases of supracondylar humerus fracture.…”

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“…There were no cases of reduction loss after the operation as we tried to engage opposite cortex in all the cases. Although recent literate shows that only lateral pinning may be sufficient to fix supracondylar fracture [48] . In our study, there are no cases of non union in both the groups as distal humerus is uncommon location.…”

“…In the late group, excellent result was seen in 68.4 % cases, good result in 21.1% cases and poor result in 10.5% cases. 15% of 132 Malaysian children with supracondylar fractures were reported to present late [48,49,50] . In our study arc of motion, range of motion, loss of flexion, extension and change in Baumann's angle were comparable between early and late groups with p value>0.005.…”

Surgical Outcomes of Pediatric Humeral Supracondylar Fractures Treated By Posterior Approach and Triceps Splitting

“…The main aim of the treatment of displaced Gartland type III humeral supracondylar fractures in children is to gain a perfect anatomical reduction, full range of motion and cosmetically acceptable extremity [13][14][15][16]. Closed reduction and percutaneous pinning of these fractures has been accepted as a choice treatment in reaching these goals by many authors [17,18].…”