AN ANALYSIS OF OPEN REDUCTION OF IRREDUCIBLE SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

OBJECTIVES: TO review experience with irreducible supracondylar fractu res requiring open reduction in children, and to propose guidelines fo r an open approach to supracondylar fractures. DESIGN: A chart review. SETTING: The Children's Hospital of Eastern Ontario (CHEO), a pediatr ic centre with a large referral base. PATIENTS: Forty-one children (18 boys 23 girls, average age 7 years), who had open reduction of irredu cible supracondylar fractures at the CHEO over a 10-year period (1985 to 1995). Of these 41 children, 7 were lost to direct follow-up. INTER VENTIONS: After closed reduction of displaced supracondylar fractures of the humerus failed, all patients underwent open reduction and percu taneous fixation in the operating room. Before operation, 6 had no rad ial pulse, 5 lost their pulse with flexion after reduction and 4 had u nstable fracture patterns. MAIN OUTCOME MEASURES: Assessment of elbow range of motion and carrying angle, distal neurovascular status and ra diographic measurement of the Baumann angle and the humerocapitellar a ngle. RESULTS: In 25 children, the humerus was found to have ''buttonh oled'' through the brachialis muscle; 1 had entrapment of the common f lexor muscle at its origin and 1 had entrapment of the triceps. In 15 children there was entrapment or tethering of the median nerve and rad ial nerve or brachial artery, or both, but this was not predictive of preoperative neurovascular deficit, which a as recorded in 21 patients (fully recovered). At follow-up, the Baumann angle and the humerocapi tellar angle differed by an average of 2 degrees and 5.3 degrees respe ctively compared with the unaffected arm. Range of motion was satisfac tory in 94% of patients, and there was no significant cubitus varus. C ONCLUSION: Open reduction of supracondylar fractures is a safe and eff ective procedure, for which orthopedists should should lower their thr eshold, given certain appropriate indicators.