Clinical Studies on the Supracondylar Fractures of the Humerus in Chilldren

Choi, Chang Uk; Rah, Soo Kyoon; Seo, Yoo Seong

Abstract

Supracondylar fractures of the humerus is the most common elbow fractures in children. The fractures so designated are in the supracondylar area of the humerus just proximal to the elbow, and do not directly involve the joint or the distal humeral epiphysis. Unfortunately, it can also be one of the most difficult fractures to treat. And the catastrophic picture of Volkmann's ischemic contracture and nerve injuries associated with these fractures, as after successful reduction, the late complications of loss of elbow motion, the chage in carrying angle, myositis ossifgicans, and delayed ulnar nerve palsy still lie ahead. For the period of 4 years and 10 months from May 1979 to March 1985, 47 patients who had been treated for supracondylar fractures of the humerus at the Department of Orthopaedic Surgery, college of medicine, Soon Chun Hyang University Hospital, are presented, The results obtained are as follows; 1. Supracondylar fractures of the humerus frequently occured between the ages of 4 and 9 years (70.2%) and the sex ratio was 2.1: 1 in male to female. 2. Of all fratures, 89.4% were the extension type and the left side was predominent in 55.3% than right. 3. According to the Holmberg clasification, Group 1 was 6 cases(12.8%), 10 cases(21.3%) in Group 2, 11 cases(23.4%) in Group 3, and 20 cases(42.5%) in Group 4. 4. Closed reduction with percutaneous pinning showed little changes in carrying angle. 5. Limitation of motion was most frequent complication after closed reduction with plaster cast immobilization. 6. By the modified Mitchell and Adams' criteria for grading results, excellent were obtained in 55.3 %, good in 44.7%, and zero in unsatisfactory. 7. In the neurovascular injuries associated with fractue, there were 4 neural injuries, and 2 vascular injuries. In 4 traumatic neuropathies, median nerve was involved most commonly and the were recovered spontaneously within 5 weeks. 8. Average time from injury to reduction was 1.6 day and delayed reduction or operation made worse the prognosis in most cases.