Closed Reduction and Casting Versus K-wire Fixation of Gartland Type II Supracondylar Fracture Humerus in Children: Radiographic Outcome and Complications
Keywords:
Supracondylar fracture, Gartland type II, Closed reduction & casting, K-wire fixation, Radiographic outcome, ComplicationsAbstract
Background: Supracondylar fracture is the most common elbow fracture in children. There is substantial agreement on managing Gartland type I (conservative) and type III (operative) fractures. The treatment of type II fractures is still debatable. This study aimed to review the radiographic outcome and complications of type II supracondylar fractures in children treated by closed reduction & casting and closed reduction & K-wire fixation, respectively.
Methods: We retrospectively reviewed 61 children with type II fractures treated with closed reduction and casting (Group 1;32) and closed reduction K-wire fixation (Group 2;29). Radiographic outcomes and complications were analysed and compared between the two groups.
Results: Overall higher radiographic loss of reduction (LOR) was noted in group 1 compared to group 2 (40.62% vs 13.79%, p=0.0405). Higher LOR was observed in both IIA and IIB fractures in group 1, managed with closed reduction and casting (p=0.1257, p=0.0437).
We found higher LOR in group 1 with IIA fractures, where the anterior humeral line (AHL) was not intersected the capitellum (p=0.0224). We noted more complications in group 1 patients compared to group 2 (28.12% vs 17.24%, p=0.316), and most of these complications were due to reoperation following the loss of reduction.
Conclusion: Higher LOR and complications were noted in type II fractures managed by closed reduction and casting (Group 1) alone. Our study supports K-wire fixation in some cases of type IIA fracture, where the AHL is not intersecting the capitellum and in all cases of type IIB fractures.
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