The Treatment of Supracondylar Fracture of the Humerus in Children

Kang, Jae Do; Kim, Chul Un

Abstract

Supracondylar fracture of the Humerus is the most common fracture of the elbow in children and frequently there are accompanying complications. A total of 78 children with supracondylar fracture of the humerus were treated at the Wallace Memorial Baptist Hospital, Busan, Korea, during a recent 5 year period. Of these, 33 patients were treated by lateral skeletal traction through olecranon pin and 14 of these were followed up for more than 6 months. 1. The average age was 7.2 years and the male and female ratio was 2.4:1. The left humerus was involved in 49 patients (62.5%). 2. Of all fractures, 94.4% were the extension type and 5.6% were the flexion type. 3. Satisfactory results wire obtained in 31 of 33 cases who were treated by lateral skeletal traction. Among these, 14 cases were followed up for more than 6 months. Final results were analyzed according to Mitchells classification; excellent results were obtained in 11 cases (78.6%), good results in 3 cases (21.4%) and there were no unsatisfactory results. 4. In 11 cases in which immediate closed reduction or Dunlops traction followed by closed reduction was unsuccessful, satisfactory results were obtained in 10 of 1 1 cases by using lateral skeletal traction. Therefore, we think that it is possible to treat most of the manual reduction failure patients by lateral skeletal traction. 5. There were two treatment failures using lateral skeletal traction. In one case, the brachialis muscle was buttonholed by the proximal fragment, and in the other case, the patient was treated 8 days after injury and marked hematoma formation between the fracture fragment was noted. 6. During treatment by lateral skeletal traction, infection developed through the pin tract in 2 cases. These were treated by the administration of antibiotics and there were no complications such as osteomyelitis nor did this effect the final results. 7. Incomplete radial nerve palsy developed in 3 cases. However, in all cases recovery was spontaneous with 4 weeks. 8. The average hospital stay for patients treated by lateral skeletal traction was 14.2 days. Prologed hospitalization is ane of the chief disadvantages of lateral skeletal traction. However, if we can minimized the number of hospital days by early cast immobiiization when the fracture is stable, lateral skeletal traction will prove to be a good method which can be expected to yield unlformly satisfactory results which are not surpassed by any other method of treatment. Since this method has been instituted at this hospital, very few patients have undergone open reduction because of fracture malalignment.