SUPRA CONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN;
Changed treatment protocol in management
DOI:
https://doi.org/10.29309/TPMJ/2013.20.03.698Keywords:
late presentation,, mishandling, difficult surgery,, increased morbidity,,, poor prognosis,, less patient satisfaction,, lifelong consequences.Abstract
Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients present
very late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years with
supra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried out
and necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:
From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from
72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation by
traditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% were
Type I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositis
ossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displaced
supracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,
because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by Open
Reduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar
5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocol
had to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full range
of movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction and
lifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus in
children different management protocols have to be made, tailored to individual needs of the patient.
