Supracondylar extension fracture of the humerus in children

We present a method of manipulative reduction, immobilisation and fixation using a U-shaped plaster with the elbow in extension for extension-type sup racondylar fractures of the humerus in children. When the elbow is in full extension, both the extensor and the flexor muscles are neutralised during manipulative reduction and the carrying angle can be easily assessed thus p reventing cubitus varus, the most common complication. In order to evaluate the efficiency of this method, we compared the clinica l results of the new method with those of conventional treatment. In a grou p of 95 children who sustained an extension-type supracondylar fracture of the humerus, 49 were treated by the new method and 46 by the conventional m ethod, reduction and immobilisation in a plaster slab with the elbow in fle xion. Reduction and immobilisation were easily achieved and reliably maintained b y one manipulation for all the children treated by the new method. In 12 ch ildren treated by the conventional method, the initial reduction failed and in seven secondary displacement of the distal fragment occurred during the period of immobilisation in plaster. All required a second or third manipu lation. Of the 46 children, 28 (60.9%) had developed cubitus varus at a mea n follow-up of 4.6 years when treated by the conventional method. None of t he children treated by the new method developed cubitus: varus. The mean sc ore, according to the Hospital for Special Surgery (HSS) elbow scoring syst em, was 91 points using the new method and 78 with the conventional method. The results were statistically significant with regard to the incidence of cubitus varus and the elbow score (p < 0.01) suggesting that the new metho d is reliable and gives a satisfactory outcome.