Treatment of supracondylar humerus fractures in children: Minimal possibleduration of immobilization

In the period from January 1980 until December 1990 we treated 147 children and adolescents with supracondylar humerus fracture, and followed the outc ome in 127 of them. Three (2.4%) patients had no displacement of fractured bones and were treated only with plaster cast immobilization. Twenty three (18.1%) underwent closed reduction of fragments and application of a plaste r cast. The majority (97; 76.4%) required manual reduction and the fixation of segments with Kirschner's wires laterally and medially. Four (3.1%) pat ients were treated with open reduction and fixation with Kirschner's wires. Both plaster cast immobilization and fragment fixation with Kirschner's wi res lasted only 14 days and were immediately followed by rehabilitation. Su ch a short immobilization of extremities or fixation of fragments did not r esult in any complication. Of 56 children available for long-term follow-up , we achieved excellent treatment results in 43 (76.6%) of the patients, go od and fair in 12 (21.5%), and a poor result in only 1 patient (1.8%). Ther e were no permanent vascular or neurological complications apart from sligh t weakness of the ulnar nerve in 3 patients. In conclusion 14 days seemed t o be the biological minimum of time needed for this type of fracture to hea l in children and adolescents. Fixation of the fragments with Kirschner's w ires and immobilization of the extremity for only 14 days brings a signific ant reduction of total treatment expenses, avoids repeated x-ray examinatio n, facilitates early physical therapy and returns the child to its family.