Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures: A systematic review

Abstract

Background: Supracondylar fractures of the humerus are the most common type of elbow fractures in childhood. Due to the potential risk of severe complications, trauma surgeons should address them with caution. Avascular necrosis of the trochlea presents a rare but oftentimes disabling complication and should not be underestimated. The aim of the present study was to identify possible predictors of avascular necrosis of the trochlea following pediatric supracondylar humerus fractures. Methods: We reviewed the available body of literature reporting clinical outcomes, complications, and possible predictors of avascular necrosis of the trochlea after supracondylar humerus fractures in childhood. Data on patient age, sex, the affected side, fracture classification, treatment, the number of K‑wires, time to surgery, complications, and the time from injury to diagnosis of avascular necrosis were obtained. This study was performed according to the PRISMA guidelines. Results: Eight clinical studies were included, comprising 30 patients with avascular necrosis after supracondylar fractures in childhood. The mean age at the time of injury was 5 years (min. 2; max. 10; SD: 2.8 years). In all, 18 patients (60.0%) were male, 11 (36.7%) were female, and one was unknown (3.3%). Five patients (16.7%) had a Gartland type I, three (10.0%) a type II, and 22 (73.3%) a type III fracture of the distal humerus. Six patients (20.0%) were treated conservatively, whereas 24 patients (80.0%) underwent operative treatment. The mean time from injury to diagnosis of avascular necrosis was 33 months (min. 4; max. 84; SD: 24.5 months). Conclusion: The available literature on avascular necrosis of the trochlea following pediatric supracondylar humerus fractures is limited. While it can occur in any supracondylar fracture, fracture displacement may be considered a risk factor.