[The treatment of dislocated supracondylar humerus fractures in childhood].

Abstract

33 children with displaced SFH were all treated operatively by open reduction and internal fixation or closed reduction and percutaneous pinning. A follow-up study was performed on average 29 (range 3-63) months after the injury. In 18% of the cases an initial injury of the neurovascular structures was observed and documented during the operation. 32 times open reduction and internal fixation by K-wires was performed, only once, closed reduction and percutaneous pinning was attempted. In the presence of a preoperative neurologic deficit, the nerves were always visualised, never, however, a nerve suture was necessary. In one case we had to reconstruct both the arteria brachialis and radialis because of intima lesions with total obstruction of the vessels. The average time of hospitalization was 9 days, which includes the time for removal of the pins, which was usually performed about 4,5 weeks later simultaneously with the removal of plaster. Using Innocenti's criteria, 27 of 30 reviewed patients had an excellent result, 3 had a good result. Early complications due to the operation such as wound healing problems, infection or nerve lesions did not occur. 3 patients could not be reached any more. We recommend for the management of the displaced SFH open reduction and internal fixation by K-wires as the method of choice. Percutaneous pinning is a valid alternative when closed reduction succeeds easily at the first attempt.