Gartland Type Iii Supracondylar Fracture Humerus

Abstract

Objectives: The purpose of present study is: 1. To know the results of surgicalintervention of Garland type III fracture Humerus in children.2. To know the early and latecomplication of surgical intervention. Study Design: Prospective interventional study. Setting:Department of Orthopedic Unit-II, Civil Hospital Karachi. Period: February 2010 to January2012. Methods: 200 male and female patients with Gartland type III supracondylar fracture ofhumerus presenting within 24 hour of injury, with age limit varying between 1- 12 years wereincluded in our study. The anteroposterior and lateral view X-rays were taken and evaluatedfor displacement and angulation, medial/ lateral displacement and angulation and rotation ofdistal fragment. After all aseptic measures, patient under general anesthesia, through posteriorapproach skin was incised, subcutaneous tissue dissected along the line of incision. Tricepsapponeurosis was splitted and interposed soft tissue was released and fracture reduced andfixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateralview and an angle of 30o – 40o in A/P view. Wound closed in layers, aseptic dressing appliedand well-padded back slab with elbow in appropriate angle of flexion was applied and pulseswere checked. Postoperatively the hand was held elevated. Plaster of parries black slab wasremoved after four weeks; the wires were removed after six weeks. The follow-up ranged from 3to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteriafor assessing the results were based on healing period, anatomical appearance, function andradiographic appearance. Results: Excellent results according to Mitchell–Adam’s criteria wereobserved in 60 %. (120/200) cases, good results were observed in 27 % (54/200) cases. Overallexcellent to good results were observed in 87% of cases. Conclusion: It is concluded thatoutcome of surgical treatment of supracondylar fractures of humerus (Gartland type III) fixedwith medial and lateral placement of k- wires were excellent to good and it achieves stablefixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injurieswere decreased as compared to closed reduction and percutaneous k-wiring. As this method istechinically easy, less demanding and effective for stabilization and can be applied for patientswith these fractures.