UNDERREDUCED SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN: CLINICAL SIGNIFICANCE AT SKELETAL MATURITY

Abstract

We retrospectively reviewed 223 cases of supracondylar fractures of elbow treated in our hospital between the years 1996 and 2000. In 30 patients we found some degree of under-reduction of the extension element of the fracture. Twenty-two of them were evaluated close to skeletal maturity. The mean age at fracture was 5.4 years and mean follow-up was 8.2 years. The radiographic remodeling, range of elbow motion and awareness of the patients of functional limitation were evaluated. At the final follow-up17 (77%) of patients have had radiographic loss of humero-condylar angle (5 or more degrees of difference compared to an uninjured side). Eleven (50%) of the patients had limited elbow flexion, and seven (31%) of them were aware of this deficit. Most of under-reductions happened when reduction was attempted in the emergency room, or when displacement was not appreciated and a cast was applied without a reduction attempt.

The conclusions are that the patients that were left to heal with some degree of extension, have had limited end-elbow flexion and may be aware of it. Although only 3 patients felt a minor functional disability at the last follow-up the 10 patients have unsatisfactory results according the Flinn’s criteria for motion restriction. The treating surgeon must be aware of this possible outcome and be more demanding in the reduction of the extension component of a fracture. Otherwise one may expect limited elbow flexion that may be clinically significant. Although the reduction of moderately displaced fractures may seem easy, it is better done in the operating room and not in the emergency room, under general anesthesia and with radiographic control.