Low incidence of flexion-type supracondylar humerus fractures but high rate of complications

Figures & data

Table 1. The characteristics of the 7 patients with a flexion-type supracondylar humerus fracture

Patient no.	I	II	III	IV	V	VI	VII
Sex	Male	Female	Male	Male	Male	Male	Female
Age	12	6	12	14	8	10	8
Injured side	Left	Left	Left	Right	Left	Left	Left
Mechanism of injury	Traffic	Falling	Trampoline	Falling	Wrestling	Falling	Falling
Local edema	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Abnormal neurological findings	No	No	Ulnar nerve paresthesia	Non-specific deficit	Non-specific deficit	No	Non-specific sensory deficit
Gartland-Wilkins classification	I	IV	III/II	IV	IV	II	IV
Pirone classification	IIA	IIB	III/IIB	IIB	III	IIB	IIB
Other radiographic noting					Intra-articular fracture
Treatment	Casting in situ	Closed reduction and 2 radial pins	Closed reduction and 2 radial pins	Open reduction and 2 pins	Closed reduction and 2 pins	Open reduction and 3 medial pins	Open reduction and 2 pins
Immobilization time, days	24	31	35	30	43	36	28
Reoperation (if any, what)	No	No	1 day later: closed re-reduction and 2 pins	3 days later: closed reduction and further fixation with 1 pin	No	No	No
Long-term outcome
Follow-up time, years	11	10	10	9	10	8	5
Flynn’s criteria	Good	Good	Excellent	Poor	Fair	Good	Poor
DASH score	1.7	0	3	0	0	0	32
MEPS	95	100	100	95	100	100	70
Carrying angle^a	−19/−19	−24/−14	−15/−14	−42/−21	−24/−13	−8/−4	−16/−14
Grip strength^b	54/50	24/24	48/50	42/42	56/46	54/54	20/28
Flexion-extension ROM^c	124/130	156/156	163/156	142/146	162/164	154/162	90/150
Forearm rotation ROM^c	164/166	170/174	167/167	154/154	160/165	154/154	145/170

DASH: disability of arm, shoulder and hand scoring (0 lowest disability and 100 highest disability);

ROM: range of motion;

MEPS: Mayo elbow performance score (100 highest performance and 0 lowest performance).

a degrees; injured/uninjured side (− valgus, + varus)

b Nm; injured/uninjured side; determined with a Jamar dynamometer.

c Range of motion in degrees; injured/uninjured side.

Figure 1. The primary radiographs (anterior-posterior and lateral projection) of all flexion-type supracondylar humerus fractures (cases I–VII) during the 10 years of the study period (2000–2009). Postoperative radiographs and the radiographs at the last short-term follow-up visit are also presented.

Figure 2. A radiographic investigation (antero-posterior and lateral projections) of the elbow showing an increased carrying angle 9 years after the injury. The patient (case IV) was 14 years old when he sustained a Gartland-Wilkins type-IV supracondylar humerus fracture.

Table 2. Long-term clinical recovery of flexion-type supracondylar humerus fractures mean 9 (5–11) years after the injury

	Injured elbow			Uninjured elbow
	Mean	SD	Range	Mean	SD	Range
Elbow ROM^a	142	27	90 to 163	152	12	130 to 164
Flexion	144	12	124 to 154	145	11	124 to 156
Extension	2	18	–15 to 40	–7	3	–12 to –2
Forearm ROM^a	159	9	145 to 170	164	8	154 to 174
Supination	79	7	65 to 86	84	4	78 to 90
Pronation	80	7	70 to 90	80	6	74 to 90
Carrying angle^b	–21	11	–42 to –8	–14	5	–21 to 0
Grip strength, Nm^c	43	15	20 to 56	42	12	24 to 54

a Range of motion, degrees

b Carrying angle, degrees: − valgus, + varus.

c Measured with a hydraulic dynamometer; the highest of 3 recordings.

Table 3. Outcome measurements for the patients with a former flexion-type supracondylar humerus fracture mean 9 years after the injury

	n	Mean	SD	Range
MEPS^a		94	11	70–100
> 85^b	6
< 85	1
DASH scorec		5	12	0–32
Flynn’s criteria, n
Satisfactory	4
Excellent/Good	1/3
Unsatisfactory	3
Fair/Poor	1/2

a Mayo elbow performance score (max. 100 points)

b Minimal clinically significant difference (MCSD) = 15 points.c Disabilities of the arm, shoulder, and hand questionnaire (DASH): 0–100 points; the higher the number of points the greater the disability.

Table 4. Patient demographics, fracture classification, and treatment of flexion-type supracondylar fractures in children according to the current study and the literature available since 1990

	Current study	Williamson (1991)	De Boeck (2001)	Garg (2007)	Mahan (2007)	Khare (2010)
Number of patients	7	14	29	14	58	22
Incidencea, b	0.81/105	NA	NA	NA	NA	NA
Male sex	5	8	24	10	22	9
Mean age, years	10	7	8.3	6.4	7.4	6.4
(range)^b	(6–14)	(1.6–14)	(7.2–10)	(4–10)	(NA)	(6–10)
Fracture type according to Gartland^c
I		0	7	3	0	5
II		11	9	5	12	17
III (including type IV^d)		3	13	6	44^e	0
Treatment
Cast		0	7	3	0	22
Closed reduction and pinning		14	22	7	40	0
Open reduction and pinning		0	0	4	18	0

a Incidence in child population <16 years of age.

b NA: not available.

c The classification of Pirone et al. (1987) used in Williamson et al. 1991.

d type IV according to Leitch et al. (2006).

e 2 cases without classification.

Leitch K K, Kay R M, Femino J D, Tolo V T, Storer S K, Skaggs D L. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified gartland type-IV fracture. J Bone Joint Surg Am 2006; 88 (5): 980–5.

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