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Treatment of Flexion-Type Supracondylar Humerus Fractures in Pediatric Patients
Sudarshan J Mohan, BS1, Danielle A Hogarth, BS1, Niyathi Prasad, BS2, Casey M Codd, BA1, Paul D. Sponseller, MD, MBA3, Christine Ann Ho, MD4 and Joshua M Abzug, MD1, (1)University of Maryland School of Medicine, Baltimore, MD, (2)Johns Hopkins School of Medicine, Baltimore, MD, (3)Orthopaedics, Johns Hopkins University, Baltimore, MD, (4)Orthopaedics, Children's Medical Center-Texas Scottish Rite Hospital for Children, Dallas, TX

Introduction Supracondylar humerus fractures are the most common elbow fractures in children, with flexion-type fractures accounting for only 2-3% of all supracondylar humerus fractures. As a result, there is a limited number of studies pertaining to this type of supracondylar humerus fracture. The purpose of this study was to investigate the various treatment aspects of flexion type supracondylar humerus fractures in the pediatric population.
Materials & Methods A retrospective review was performed surrounding the operative treatment of flexion type supracondylar humerus fractures at two institutions over a 25-year period. Patient demographics, mechanisms of injury, diagnostic modalities, time to surgery, pin size and configuration, time to fracture union, and complications were recorded. Simple statistics were performed.
Results A total of 17 patients, 3 to 12 years of age (mean: 7.55; SD: 2.56), were identified. Of the 17 patients, 88% (N=15) sustained the injury from a fall. The time to surgery was 24 hours for 40% (N=6). 65% (N=11) of the patients were treated with closed reduction and percutaneous pinning and the remaining 35% (N=6) were treated with open reduction and internal fixation. The Baumann's angle following operative intervention ranged from 61 to 77 degrees (mean: 69.64; SD: 5.39) and the anterior humeral line was in the middle third of the capitellum for 31% (N=4) and the posterior third for 69% (N=9). 50% (N=8) of the pin configurations were lateral only pins utilizing 2 pins (37.5%, N=3), 3 pins (50%, N=4), and 4 pins (12.5%, N=1). The other 50% (N=8) were treated with a crossed pin configuration using 2 pins (37.5%, N=3), 3 pins (37.5%, N=3), and 4 pins (25%, N=2). The overall complication rate was 41% (7/17). The most common complication was decreased range of motion which accounted for 57% (N=4) of complications. Other complications included one infection (N=1), one obvious malrotation at the fracture site on the post-operative radiographs (N=1), and an additional surgery to replace the pin fixation with cannulated screws due to loss of reduction (N=1).
Conclusions There is a high complication rate associated with flexion type supracondylar humerus fractures in the pediatric population. Further studies are needed to determine the optimal treatment of these infrequent fractures.


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