GARTLAND TYPE III SUPRACONDYLAR FRACTURE HUMERUS

SURGICAL MANAGEMENT

Abstract

Objectives: The purpose of present study is: 1. To know the results of surgical
intervention of Garland type III fracture Humerus in children.2. To know the early and late
complication of surgical intervention. Study Design: Prospective interventional study. Setting:
Department of Orthopedic Unit-II, Civil Hospital Karachi. Period: February 2010 to January
2012. Methods: 200 male and female patients with Gartland type III supracondylar fracture of
humerus presenting within 24 hour of injury, with age limit varying between 1- 12 years were
included in our study. The anteroposterior and lateral view X-rays were taken and evaluated
for displacement and angulation, medial/ lateral displacement and angulation and rotation of
distal fragment. After all aseptic measures, patient under general anesthesia, through posterior
approach skin was incised, subcutaneous tissue dissected along the line of incision. Triceps
apponeurosis was splitted and interposed soft tissue was released and fracture reduced and
fixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateral
view and an angle of 30o – 40o in A/P view. Wound closed in layers, aseptic dressing applied
and well-padded back slab with elbow in appropriate angle of flexion was applied and pulses
were checked. Postoperatively the hand was held elevated. Plaster of parries black slab was
removed after four weeks; the wires were removed after six weeks. The follow-up ranged from 3
to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteria
for assessing the results were based on healing period, anatomical appearance, function and
radiographic appearance. Results: Excellent results according to Mitchell–Adam’s criteria were
observed in 60 %. (120/200) cases, good results were observed in 27 % (54/200) cases. Overall
excellent to good results were observed in 87% of cases. Conclusion: It is concluded that
outcome of surgical treatment of supracondylar fractures of humerus (Gartland type III) fixed
with medial and lateral placement of k- wires were excellent to good and it achieves stable
fixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injuries
were decreased as compared to closed reduction and percutaneous k-wiring. As this method is
techinically easy, less demanding and effective for stabilization and can be applied for patients
with these fractures.