Operative Management of Displaced Flexion Supracondylar Humerus Fractures in Children

Abstract

Flexion-type supracondylar humerus fractures remain an uncommon variant of the common extension-type injury. They are often thought to be more difficult injuries, more probable to require open reduction, and have neurovascular complications. We reviewed the 10-year history of flexion-type supracondylar elbow fractures treated at 1 institution and compared these cases with those of an extension-type cohort collected during a similar period. The patients in the flexion-type group (mean age, 7.5 years) were significantly older than those in the extension-type group (mean age, 5.8 years). The fractures in flexion-type group were also more probable to require open reduction (31%) than those in the extension-type group (10%). There was no difference in the incidence of preoperative nerve symptoms; however, the flexion-type group had a significantly increased incidence rate of ulnar nerve symptoms (19% vs 3% in the extension-type group) and need for ulnar nerve decompression. The flexion-type variant should be recognized preoperatively, and the potential pitfalls involved with the treatment of these injuries appreciated.

Beware of ulnar nerve entrapment in flexion-type supracondylar humerus fractures

“…Flexion-type supracondylar fractures remain a relatively uncommon variant of childhood supracondylar fractures [3,5]. There has been a greater need for ORIF of these flexion-type supracondylar fractures as well as a higher rate of injury to the ulnar nerve than observed with the extension-type fracture pattern [2,3,5].…”

Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic

“…Flexion type SHFs are uncommon types of supracondylar fractures and were reported to account for only 2 to 10% of distal humerus fractures in children. [2][3][4][5][6] Flexion type SHFs are thought to require open reduction more often than extension types and probability of iatrogenic or preoperative nerve injury is also higher. [5] There are various described techniques about the treatment of these injuries in the literature such as manipulation and casting in flexion or extension, overhead traction, closed reduction and percutaneous pinning (CRPP), and open reduction and internal fixation (ORIF).…”

“…[2][3][4][5][6] Flexion type SHFs are thought to require open reduction more often than extension types and probability of iatrogenic or preoperative nerve injury is also higher. [5] There are various described techniques about the treatment of these injuries in the literature such as manipulation and casting in flexion or extension, overhead traction, closed reduction and percutaneous pinning (CRPP), and open reduction and internal fixation (ORIF). [7] These described treatment options are based on a limited number of small sized case series because there are not much data about these fractures in the literature.…”

Desvios rotacionais na fratura supracondiliana do úmero em crianças: novo método de avaliação

“…O mecanismo de trauma mais comum é a queda com apoio do membro superior e o cotovelo em extensão completa, levando o olécrano a realizar um fulcro posterior na sua fossa, região de maior fragilidade, provocando uma fratura do tipo em extensão, isto é, com desvio posterior (8,9) . Este tipo de desvio representa cerca de 97% a 99% dos casos (5,8) .…”

“…Dentre estas, as fraturas supracondilianas do úmero são responsáveis por até 50 a 70% dos casos (2)(3)(4) , acometendo principalmente crianças na faixa etária entre cinco e sete anos de idade (5) . As lesões ocorrem predominantemente à esquerda, ou do lado não dominante (5-7) .O mecanismo de trauma mais comum é a queda com apoio do membro superior e o cotovelo em extensão completa, levando o olécrano a realizar um fulcro posterior na sua fossa, região de maior fragilidade, provocando uma fratura do tipo em extensão, isto é, com desvio posterior (8,9) . Este tipo de desvio representa cerca de 97% a 99% dos casos (5,8) .…”