Treatment of Gartland type <b>Ⅱ</b> and <b>Ⅲ</b> supracondylar fracture of humerus in children _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Qing ¹ ,  KONG Qingquan ² , GAO Bo ¹

1. Department of Orthopedics, People’s Hospital of Deyang City, Deyang Sichuan, 618000, P.R.China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

KONG Qingquan, Email: kongspine@126.com

Keywords：

Supracondylar fracture of the humerus; reduction; internal fixation; child

DOI：

10.7507/1002-1892.201710021

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ObjectiveTo analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children.MethodsBetween January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years (mean, 5.7 years). The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours (mean, 4.6 hours). All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed.ResultsThe operation time was 16-52 minutes (mean, 32 minutes). The perspective frequency was 4-17 times (mean, 6.7 times). The hospitalization time was 3-7 days (mean, 4 days). All the 45 cases were followed up 8-20 months (mean, 12 months). The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in 1 case, and the excellent and good rate was 92.3%.ConclusionGartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.

Citation： ZHOU Qing, KONG Qingquan, GAO Bo. Treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of humerus in children . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 698-702. doi: 10.7507/1002-1892.201710021 Copy

1.	Kazimoglu C, Cetin M, Sener M, et al. Operative management of type Ⅲ extension supracondylar fractures in children. Int Orthop, 2009, 33(4): 1089-1094.
2.	Turban EC, Aksoy C, Ege A, et al. Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study). Arch Orthop Trauma Surg, 2008, 128(7): 739-744.
3.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
4.	Millis MB, Singer IJ, Hall JE. Supracondylar fracture of the humerus in children.Further experience with a study in orthopaedic decision-making. Clin Orthop Relat Res, 1984, (188): 90-97.
5.	Larson L, Firoozbakhsh K, Pasarelli R, et al. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2006, 26(5): 573-578.
6.	Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg (Am), 2008, 90(5): 1121-1132.
7.	Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg, 1997, 5(1): 19-26.
8.	Wilkins KE. Supracondylar fractures: what’s new? J Pediatr Orthop B, 1997, 6(2): 110-116.
9.	Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop, 2012, 32 Suppl 2: S143-152.
10.	Tomaszewski R, Wozowicz A, Wysocka-Wojakiewicz P. Analysis of early neurovascular complications of pediatric supracondylar humerus fractures: a long-term observation. Biomed Res Int, 2017, 2017: 2803790.
11.	Lee YH, Lee SK, Kim BS, et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop, 2008, 28(4): 417-422.
12.	Patriota GS, Assun??o Filho CA, Assun??o CA. What is the best fixation technique for the treatment of supracondylar humerus fractures in children? Rev Bras Ortop, 2017, 52(4): 428-434.
13.	Lee SS, Mahar AT, Miesen D, et al. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002, 22(4): 440-443.
14.	孫建中, 史建靖, 翁益民, 等. Baumann 角在兒童肱骨髁上骨折經皮固定術中的臨床應用. 中華小兒外科雜志, 2005, 26(5): 249-252.
15.	Yadav UB, Singhal R, Tonk G, et al. Crossed pin fixation in displaced supracondylar humerus fractures in children. Indian J Orthop, 2004, 38(3): 166-169.
16.	Hussain S, Ahmad M, Muzaffar T. Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach. Chin J Traumatol, 2014, 17(3): 130-135.
17.	Silva M, Kazantsev M, Aceves Martin B, et al. Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction? J Pediatr Orthop B, 2018, 27(2): 103-107.
18.	Ersan O, Gonen E, Arik A, et al. Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method. Int Orthop, 2009, 33(5): 1371-1375.
19.	南國新, 劉國棟, 覃佳強, 等. 前路橫切口治療兒童 Gartland Ⅲ 型肱骨髁上骨折. 中華創傷雜志, 2012, 28(2): 120-124.
20.	Wang SI, Kwon TY, Hwang HP, et al. Functional outcomes of Gartland Ⅲ supracondylar humerus fractures with early neurovascular complications in children. Medicine (Baltimore), 2017, 96(25): e7148.
21.	Keskin D, Sen H. The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning. Acta Chir Orthop Traumatol Cech, 2014, 81(6): 380-386.

1. Kazimoglu C, Cetin M, Sener M, et al. Operative management of type Ⅲ extension supracondylar fractures in children. Int Orthop, 2009, 33(4): 1089-1094.
2. Turban EC, Aksoy C, Ege A, et al. Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study). Arch Orthop Trauma Surg, 2008, 128(7): 739-744.
3. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
4. Millis MB, Singer IJ, Hall JE. Supracondylar fracture of the humerus in children.Further experience with a study in orthopaedic decision-making. Clin Orthop Relat Res, 1984, (188): 90-97.
5. Larson L, Firoozbakhsh K, Pasarelli R, et al. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2006, 26(5): 573-578.
6. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg (Am), 2008, 90(5): 1121-1132.
7. Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg, 1997, 5(1): 19-26.
8. Wilkins KE. Supracondylar fractures: what’s new? J Pediatr Orthop B, 1997, 6(2): 110-116.
9. Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop, 2012, 32 Suppl 2: S143-152.
10. Tomaszewski R, Wozowicz A, Wysocka-Wojakiewicz P. Analysis of early neurovascular complications of pediatric supracondylar humerus fractures: a long-term observation. Biomed Res Int, 2017, 2017: 2803790.
11. Lee YH, Lee SK, Kim BS, et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop, 2008, 28(4): 417-422.
12. Patriota GS, Assun??o Filho CA, Assun??o CA. What is the best fixation technique for the treatment of supracondylar humerus fractures in children? Rev Bras Ortop, 2017, 52(4): 428-434.
13. Lee SS, Mahar AT, Miesen D, et al. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002, 22(4): 440-443.
14. 孫建中, 史建靖, 翁益民, 等. Baumann 角在兒童肱骨髁上骨折經皮固定術中的臨床應用. 中華小兒外科雜志, 2005, 26(5): 249-252.
15. Yadav UB, Singhal R, Tonk G, et al. Crossed pin fixation in displaced supracondylar humerus fractures in children. Indian J Orthop, 2004, 38(3): 166-169.
16. Hussain S, Ahmad M, Muzaffar T. Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach. Chin J Traumatol, 2014, 17(3): 130-135.
17. Silva M, Kazantsev M, Aceves Martin B, et al. Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction? J Pediatr Orthop B, 2018, 27(2): 103-107.
18. Ersan O, Gonen E, Arik A, et al. Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method. Int Orthop, 2009, 33(5): 1371-1375.
19. 南國新, 劉國棟, 覃佳強, 等. 前路橫切口治療兒童 Gartland Ⅲ 型肱骨髁上骨折. 中華創傷雜志, 2012, 28(2): 120-124.
20. Wang SI, Kwon TY, Hwang HP, et al. Functional outcomes of Gartland Ⅲ supracondylar humerus fractures with early neurovascular complications in children. Medicine (Baltimore), 2017, 96(25): e7148.
21. Keskin D, Sen H. The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning. Acta Chir Orthop Traumatol Cech, 2014, 81(6): 380-386.

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