Background Supracondylar humeral fractures are one of
the most common skeletal injuries in children. In cases of
displacement and instability, the standard procedure is
early closed reduction and percutaneous Kirschner wire
fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected
fractures are those patients who presented for treatment
after 14 days of injury. The delay is either due to lack of
medical facilities or social and financial constraints. The
neglected cases are often closed injuries with no vascular
compromise. However, the elbow may still be tense and
swollen with abrasions or crusts. In neglected cases,
especially after early appearance of callus, there is no place
for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with
surgical approaches that disrupt the extensor mechanism
with less satisfactory functional outcome due to triceps
weakness and elbow stiffness. The aim of this study is to
evaluate the outcome of delayed open reduction using the
triceps-sparing approach and Kirschner wire fixation for
treatment of neglected, displaced supracondylar and distal
humeral fractures in children.
Materials and methods This prospective study included
15 children who had neglected displaced supracondylar
and distal humeral fractures. All patients were completely
evaluated clinically and radiologically before intervention,
after surgery and during the follow-up. The follow-up
period ranged from 8 to 49 months, with a mean period of
17 months. Functional outcome was evaluated according to
the Mayo Elbow Performance Index (MEPI) and Mark
functional criteria.
Results All fractures united in a mean duration of
7.2 weeks (range 5–10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last
follow-up in 13 of the 15 patients studied (86.66 %), while
good results were found in two patients (13.33 %) according
to the MEPI scale. According to the Mark functional criteria,
there was one patient with a fair result (6.66 %).
Conclusion The results were very satisfactory if compared with traditional operative techniques, with many
advantages including anatomical reduction and fixation of
the fractures, avoidance of ulnar nerve injury, preservation
of the extensor mechanism, decrease in incidence of
myositis ossificans around the elbow and decrease in postoperative stiffness.
Level of evidence IV. |
