Reliability of a modified Gartland classification of supracondylar humerus fractures.

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Abstract

[Indexed for MEDLINE] 3. Ir J Med Sci. 2023 Dec;192(6):2845-2849. doi: 10.1007/s11845-023-03294-w. Epub 2023 Feb 28. Single-surgeon perspective: is there ever a need to open extension-type supracondylar fractures? Low LYH(1), Barry ME(2), Condell R(2), Clesham K(2), Devitt AT(2). Author information: (1)Department of Trauma and Orthopaedics, University Hospital Galway, Newcastle Road, Galway, Ireland. lowl@tcd.ie. (2)Department of Trauma and Orthopaedics, University Hospital Galway, Newcastle Road, Galway, Ireland. BACKGROUND: Supracondylar humerus fractures (SCHFs) represent the most common pediatric elbow fracture, constituting approximately 12-17% of all pediatric fractures. The vast majority of operative supracondylar humerus fractures are treated with closed reduction and percutaneous pinning (CRPP); however, the estimated rate of SCHFs requiring open reduction is approximately 12.7%. AIM: This study aims to analyze the likelihood of open reduction in pediatric extension-type SCHFs and to reaffirm the traditional teaching of reduction techniques described by Smith and Rang. METHODS: A single-surgeon retrospective analysis of 56 operative pediatric SCH cases (51 extension-type, 6 flexion-type) who underwent either CRPP or open reduction over a 16-year period was performed. All cases were performed using the aforementioned reduction technique. The Modified Gartland's classification was utilized in the analysis of extension-type SCHF radiographs. RESULTS: Gartland IIA fractures constituted 38% of SCHFs, 9% of Gartland IIB, 43% of Gartland III, and 7% of flexion-type. The rate of open reduction in SCHFs was 1.8% (1 out of 56 cases), performed in a flexion-type injury. All extension-type fractures were successfully managed with either CRPP or manipulation and casting alone. Of the cases requiring CRPP, 45% were divergent lateral wires, and 55% were crossed wires. CONCLUSIONS: In our series, a 1.8% rate of open reduction was indicated in flexion-type SCH fractures. All 52 cases of extension-type SCHFs were successfully managed with closed reduction with or without percutaneous pinning. Successful closed reduction using the concept of intact periosteal hinge to aid and maintain reduction is crucial. © 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland. DOI: 10.1007/s11845-023-03294-w