Open Versus Percutaneous Cross K-Wires Fixation for Displaced Supracondylar Fractures of the Humerus in Children Muzahim Ahmed Abbas* FIBMS, Laith Saleem Sabri* FIBMS, Salwan Akram Salwo* FIBMS

Abstract

ABSTRACT Background: Supracondylar fractures of the humerus are common injuries in children. It represents 17% of all childhood fractures. The peak age of fracture is 5 to 7 years. The vast majority of supracondylar fractures of the humerus are of extension type (97%). Flexion-type injuries also occur but it is rare (3%). Objective: To compare the outcome results of surgical closed reduction to open reduction with cross-pinning fixation in Gartland type II and III extensions type supracondylar humeral fracture in children

Methods: During the period between February 2014 and March 2016, we made a caseseries study of (20) patients collected from the emergency unit of Al-Kindy Teaching Hospital, suffered from Gartland type II and III supracondylar humeral fracture extension type. They were managed surgically with either closed reduction (10 children) or open reduction (10 children), both with cross pinning fixation. The study includes (13) boys and (7) girls with a mean age of (6) years. We chose two surgical means of fixation; open and percutaneous randomly and we tried to compare between the two

Results: All the (20) patients were followed-up, clinically and radiographically evaluated pre-surgery, post-surgery and finally (6) months after surgery. Radiologically, after surgery in both groups anterior humeral lines cross the capitellum in all patients. At the same time all Baumann’s angles were in the normal range, and in comparison with contralateral side all differences less than 5º except one case treated by percutaneous method it was about 6º difference. At the last follow-up (after 6 months), patients were assessed functionally according to Flynn’s criteria. Range of motion in flexion, extension of the elbow was the functional parameter in our study in addition to carrying angle as graded by the Flynn’s grading system. In open surgery group: we obtained an outcome of excellent results in (8) patients (80%), good results in (1) patient (10%) and fair in (1) patient (10%). In percutaneous surgery group: we obtained an outcome of excellent results in (8) patients (80%), good results in (2) patients (20%). The results in both groups were satisfactory and we have no poor results in both.

Conclusions: In spite of approximated results, a long list of advantages make percutaneous method as an effective modality of surgical treatment in comparison with open method. Closed reduction with percutaneous pinning is believed to represent a reliable method of managing displaced supracondylar fractures in children, reduces hospitalizations, physical therapy, with less complications and faster return to daily activities of children. Giving good and excellent results.