Closed Reduction and Casting Versus K-wire Fixation of Gartland Type II Supracondylar Fracture Humerus in Children: Radiographic Outcome and Complications
Abstract
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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References
Steenbrugge FMM. Guidelines and pitfalls in the management of supracondylar humerus fractures in children. Current Orthopaedics. June 2001; 15(3):214-219. DOI:10.1054/cuor.2001.0168
GARTLAND JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959 Aug;109(2):145-54. PMID: 13675986.
Wilkins KE. Fractures and dislocation of the elbow region. In: Rockwood CA, Wilkins KE, King RE, eds. Fractures in Children. Philadelphia, PA: JB Lippincott; 1984:365–575.; vol. 3.
Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am. 2008 May;90(5):1121-32. doi: 10.2106/JBJS.G.01354. PMID: 18451407.
Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture stability after pinning of displaced supracondylar distal humerus fractures in children. J Pediatr Orthop. 2001 May-Jun;21(3):313-8. PMID: 11371812.
Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001 May;83(5):735-40. PMID: 11379744.
Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop. 2008 Mar;28(2):139-41. doi: 10.1097/BPO.0b013e3181653ac8. PMID: 18388704.
Hadlow AT, Devane P, Nicol RO. A selective treatment approach to supracondylar fracture of the humerus in children. J Pediatr Orthop. 1996 Jan-Feb;16(1):104-6. doi: 10.1097/00004694-199601000-00021. PMID: 8747365.
Parikh SN, Wall EJ, Foad S, Wiersema B, Nolte B. Displaced type II extension supracondylar humerus fractures: do they all need pinning? J Pediatr Orthop. 2004 Jul-Aug;24(4):380-4. doi: 10.1097/00004694-200407000-00007. PMID: 15205619.
Padman M, Warwick AM, Fernandes JA, Flowers MJ, Davies AG, Bell MJ. Closed reduction and stabilization of supracondylar fractures of the humerus in children: the crucial factor of surgical experience. J Pediatr Orthop B. 2010 Jul;19(4):298-303. doi: 10.1097/BPB.0b013e328333ab18. PMID: 20431491.
Heal J, Bould M, Livingstone J, Blewitt N, Blom AW. Reproducibility of the Gartland classification for supracondylar humeral fractures in children. J Orthop Surg (Hong Kong). 2007 Apr;15(1):12-4. doi: 10.1177/230949900701500104. PMID: 17429110.
Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM. Does the Modified Gartland Classification Clarify Decision Making? J Pediatr Orthop. 2018 Jan;38(1):22-26. doi: 10.1097/BPO.0000000000000741. PMID: 26974527.
Lovell WW, Winter RB, Morrissy RT, Weinstein SLV. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004 Apr;86(4):702-7. doi: 10.2106/00004623-200404000-00006. PMID: 15069133.
Lucas DE, Willis LM, Klingele KE. Factors predictive of early radiographic failure after closed reduction of Gartland type II supracondylar humeral fractures. J Orthop Trauma. 2013 Aug;27(8):457-61. doi: 10.1097/BOT.0b013e31827aa78e. PMID: 23187157.
Spencer HT, Dorey FJ, Zionts LE, Dichter DH, Wong MA, Moazzaz P, Silva M. Type II supracondylar humerus fractures: can some be treated nonoperatively? J Pediatr Orthop. 2012 Oct-Nov;32(7):675-81. doi: 10.1097/BPO.0b013e318269c459. PMID: 22955530.
Camus T, MacLellan B, Cook PC, Leahey JL, Hyndman JC, El-Hawary R. Extension type II pediatric supracondylar humerus fractures: a radiographic outcomes study of closed reduction and cast immobilization. J Pediatr Orthop. 2011 Jun;31(4):366-71. doi: 10.1097/BPO.0b013e31821addcf. PMID: 21572272.
Larson AN, Garg S, Weller A, Fletcher ND, Schiller JR, Kwon M, Browne R, Copley LA, Ho CA. Operative treatment of type II supracondylar humerus fractures: does time to surgery affect complications? J Pediatr Orthop. 2014 Jun;34(4):382-7. doi: 10.1097/BPO.0000000000000124. PMID: 24248589.
Iorio C, Crostelli M, Mazza O, Rota P, Polito V, Perugia D. Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing? J Orthop. 2018 Dec 18;16(1):31-35. doi: 10.1016/j.jor.2018.12.001. PMID: 30662234; PMCID: PMC6324759.
Zorrilla S de Neira J, Prada-Cañizares A, Marti-Ciruelos R, Pretell-Mazzini J. Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop. 2015 Nov;39(11):2287-96. doi: 10.1007/s00264-015-2975-4. Epub 2015 Aug 28. PMID: 26311512.
Bashyal RK, Chu JY, Schoenecker PL, Dobbs MB, Luhmann SJ, Gordon JE. Complications after pinning of supracondylar distal humerus fractures. J Pediatr Orthop. 2009 Oct-Nov;29(7):704-8. doi: 10.1097/BPO.0b013e3181b768ac. PMID: 20104149.
Bender J, Busch CA. Results of treatment of supracondylar fractures of the humerus in children with special reference to the cause and prevention of cubitus varus. Arch Chir Neerl. 1978;30(1):29-41. PMID: 655730.
Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013 Jan 2;95(1):28-34. doi: 10.2106/jbjs.l.00132. PMID: 23405411.
O’Driscoll SW, Spinner RJ, McKee MD, Kibler WB, Hastings H 2nd, Morrey BF, Kato H, Takayama S, Imatani J, Toh S, Graham HK. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am. 2001 Sep;83(9):1358-69. doi: 10.2106/00004623-200109000-00011. PMID: 11568199.
