Osteosynthesis and Trauma Care 2003; 11(2): 56-60
DOI: 10.1055/s-2003-42807
Original Article

© Georg Thieme Verlag Stuttgart · New York

Treatment of Supra- and Percondylar Fractures of the Humerus in Children: Consequences for Management from a Retrospective Analysis of 137 Cases

G. Pistor1 , L. Koltai2 , K. Kollecker3 , H. Graffstädt4 , M. Retz4
  • 1Former Department of Pediatric Surgery, Children’s Hospital Reinickendorferstr. 11, Free University Berlin, Germany
  • 2Department of Pediatric Surgery, Municipal Hospital Frankfurt am Main - Hoechst, Germany
  • 3Department of Pediatric Surgery, University of Mainz, Germany
  • 4Department of Pediatric Surgery, Children's Hospital Charité Berlin, Germany
Further Information

Publication History

Publication Date:
06 October 2003 (online)

Abstract

In a period of 5 years 137 children with supra- and percondylar fractures of the humerus were treated at the Department of Pediatric Surgery (Virchow-Klinikum) of the Free University of Berlin/Germany.
86 of the total cohort (62.8 %) were followed up and the outcome was related to the initial therapeutic strategies.
Impaired movement was found in 21 % of the follow-up cohort, with 14 % showing impaired flexion and 7 % impaired extension. Half of the cases with impaired extension had a reduction of movement below 10 degrees being unnoticed by the children. More pronounced movement deficit was associated with higher age, higher degree of dislocation and increased number of repositions.
The relation between the degree of dislocation and the number of repeated reductions of fractures with the higher degree of dislocation was remarkable. The worst outcome had patients with three repositions: 60 % had impaired movement and 40 % had weight-dependent pain.
Secondary dislocations of conservative treated Baumann III fractures were so frequent that a primary Kirschner-wire-fixation is recommended. Movement-deficit and weight-dependent pain in the follow-up cohort were independent from the initial degree of dislocation; the functional results of the surgical treatment (open reposition and wire-fixation) were superior to those of the non-invasive strategies. The best outcome was achieved in those cases were a definitive primary treatment was possible with anatomically reduction.
Thus these results lead to recommendations for a primary Kirschner-wire-fixation as well as primary surgical treatment to achieve a gentle and anatomically repositioning of supra- and percondylar fractures.

References

  • 1 Alburger P D, Weidner P L, Betz R. Supracondylar fractures of the humerus in children.  J Pediatr Orthop. 1992;  19 16-19
  • 2 Bialik V, Weiner A, Fishman J. Scoring system for assessing the treatment of supracondylar fractures of the humerus.  Isr J Med Sci. 1983;  19 173-175
  • 3 Celiker O, Pestilci F I, Tuzuner M. Supracondylar fractures of the humerus in children: Analysis of the results in 142 patients.  J Orthop Trauma. 1990;  4 265-269
  • 4 Chen R S, Liu C B, Lin X S, Feng X M, Zhu J M, Ye F Q. Supracondylar extension fracture of the humerus in children. Manipulative reduction, immobilization and fixation using a U-shaped plaster slab with the elbow in full extension.  J Bone Joint Surg [Br]. 2001;  83 883-887
  • 5 Ciernik F, Meier L, Hollinger A. Humeral mobility after treatment with a hanging cast.  J Trauma. 1991;  31 230-233
  • 6 Dallek U, Mommsen U, Jungbluth K H, Kahl H J. Die suprakondyläre Humerusfraktur im Kindesalter, ihre Behandlung und Ergebnisse nach der Methode von Blount.  Unfallchirurg. 1985;  11 192-196
  • 7 Davis R T, Gorczyca J T, Pugh K. Supracondylar humerus fractures in children. Comparison of operative treatment methods.  Clin Orthop. 2000;  376 49-55
  • 8 Kaewporsawan K. Comparison between closed reduction with percutaneous pinning and open reduction with pinning in children with closed totally displaced suprakondylär humeral fractures: a randomized controlled trial.  J Pediatr Orthop. 2001;  10 131-137
  • 9 von Laer L, Brunner R, Lampert C. Fehlverheilte suprakondyläre und kondyläre Humerusfrakturen.  Orthopäde. 1991;  20 331-340
  • 10 von Laer L. Frakturen und Luxationen im Wachstumsalter. Thieme, Stuttgart 2001, pp. 128 and 157
  • 11 Mehlmann C T, Strub W M, Roy D R, Wall E J, Crawford A H. The effect of surgical timing on the perioperative complications of treatment of supracondylär humeral fractures in children.  J Bone Joint Surg [Am]. 2001;  3 323-327
  • 12 O'Hara L J, Barlow J W, Clarke N M. Displaced suprakondylär fractures of the humerus in children. Audit changes practice.  J Bone Joint Surg [Br]. 2000;  2 204-210
  • 13 Pirone A M, Graham H K, Krajbich J I. Management of displaced extension-type supracondylar fractures of the humerus in children.  J Bone Joint Surg [Am]. 1988;  70 641-650
  • 14 Reigstad A, Hellum C. Volkmann's ischaemic contracture of the forearm.  Injury. 1981;  12 148-150
  • 15 Resch H, Helweg G. Die Bedeutung des Rotationsfehlers bei der suprakondylären Oberarmfraktur des Kindes.  Akt Traumatol. 1987;  17 65-72
  • 16 Schickedanz H, Maag G, Schürer E. Suprakondyläre Humerusfrakturen bei Kindern.  Beitr Orthop Traumatol. 1981;  28 12-17
  • 17 Schück R, Bartsch M, Link W. Die chirurgische Behandlung distaler Humerusfrakturen im Kindesalter.  Z Kinderchir. 1989;  44 283-285
  • 18 Schüz W, Börner M. Indikationen zur operativen und konservativen Behandlung der kindlichen suprakondylären Oberarmfrakturen sowie deren Ergebnisse.  Unfallchirurg. 1985;  11 17-27
  • 19 Seekamp A, Regel G, Blauth M, Klages U, Klemme R, Tscherne H. Langzeitergebnisse der Therapie offener und geschlossener Frakturen des Ellenbogengelenks/Long-term results of open and closed elbow fractures.  Der Unfallchirurg. 1997;  3 205-211
  • 20 Sibly T F, Briggs P J, Gibson M J. Supracondylar fractures of the humerus in childhood: range of movement following the posterior approach to open reduction.  Injury. 1991;  22 456-458
  • 21 Sigge W, Behrens K, Roggenkamp K, Würtenberger H. Vergleich von Blountscher Schlinge und Kirschner-Drahtfixation zur Behandlung der dislozierten suprakondylären Humerusfraktur im Kindesalter.  Unfallchirurg. 1987;  13 82-90
  • 22 Skaggs D L, Hale J M, Bassett J, Kaminsky C, Kay R M, Tolo V T. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement.  J Bone Joint Surg [Am]. 2001;  5 735-740
  • 23 Te Slaa R L, Faber F WM, Nollen A JG, van Straaten T. Supracondylar fractures of the humerus in children: A long-term follow-up study.  Neth J Surg. 1988;  40 100-103
  • 24 van Laarhoven C JHM, Oosterhuis K J. Operative treatment of supracondylar fractures of the humerus in children.  Neth J Surg. 1990;  42 61-62
  • 25 Wahl D. Über den posttraumatischen Cubitus varus.  Zentralbl Chirurgie. 1983;  108 1086-1094

PD Dr. G. Pistor

Kinderchirurgie a. d. G. ehem. Oskar-Helene- Heim

Clayallee 229

14195 Berlin, Germany

Phone: +49/30 84 72 12 25/12 26

Fax: +49/30 84 72 12 26

Email: Gert.Pistor@t-online.de


Kinderklinik/Kinderchirurgie

Städtisches Klinikum Brandenburg

Akad. Lehrkrankenhaus der Humboldt-Universität Berlin

Hochstr. 29

14770 Brandenburg a. d. Havel · Germany



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