Triceps-sparing Posterior Approach for Supracondylar Fractures in Children

Abstract

Background: The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% of<br />elbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation of<br />type III supracondylar humeral fractures using a Triceps sparing posterior approach.<br />Methods: In total, 98 patients were evaluated from June 2007 to 2014.<br />Results: According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and the<br />right to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which was<br />right. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internal<br />fixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3<br />months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° and<br />the obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determined<br />at 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopic<br />ossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nerve<br />palsy, two of which happened before surgery, and the other two following the surgery. All of these complications were<br />resolved within 3 to 10 weeks spontaneously.<br />Conclusion: This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptable<br />skin scar esthetically along with satisfactory postoperative function.<br />Level of evidence: IV