A Clinical Study of Supracondylar Fractures of the Humerus in Children

Park, Byung Chul; Kim, Ik Dong; Lee, Soo Young; Ihn, Joo Chul; Park, Ihi Hyung

Abstract

Supracondylar fracture of the humerus is the most common fracture about the elbow in children and much has been written about its treatment and the prevention of both Volkmann's ischemia with contracture and the nerve injuries associated with these fractures. However, it is still one of the most difficult fractures to manage and is frequently associated with significant residual complications. Among these complications, the change in carrying angle is the most common one. In a retrospective survey of 102 children with supracondylar fractures of the humerus treated at the Department of Orthopedic Surgery of Kyungpook National University Hospital, 68 cases were found to have sufficient clinical and roentgenographic data to classify the fractures and to determine the carrying angles at end result. The results are as follows: 1. The mean age of the 102 patients at the time of fracture was 7.3 years (range, 2 to 17 years), and the fractures were on the left side in 67.6%, and male comprised 70.1%. 2, Of all fractures, 98% were the extension type, and the most common direction of initial displacement of the distal fragment was postero-medial. 3. According to Arnold et al classification, fractures with moderate varus or valgus displacement were the most common types in our series. 4. In the associated injuries with fractures, there were 5 nerve palsies and 5 fractures at the other sites. 5. In our series, the carrying angle of the opposite side of the fractured elbow ranged from 2 to 23 degrees of valgus angulation, with a mean of 9.2 degrees. 6. The decrease in carrying angle was most common in fractures with postero-medial displacement. 7, As far as the position of immobilization after reduction of the fracture is concerned, there was less tendency of decreasing the carrying angle in pronated group. 8. Most cases were treated by conservative method. There was no significant difference in change of carrying angle between the cases treated by closed reduction and those by skeletal traction.