Treatment of displaced flexion-type pediatric supracondylar humeral fractures in the prone position

Abstract

Purpose: This study is to report a new method to reduce and fix the displaced flexion-type pediatric supracondylar fracture in the prone position. Methods: Ten children with displaced flexion-type supracondylar humeral fractures treated between 2007 and 2013 were reviewed. There were three girls and seven boys, with a mean age of 9.5 years. The fracture was reduced by gentle traction of the forearm and gradual extension of the elbow in the prone position. Two or three crossed Kirschner wires (K-wires) were inserted percutaneously to secure the fracture reduction. Radiographic evaluation included the Baumann’s angle and the lateral humerocapitellar angle. Clinical outcomes were assessed using the Flynn’s criteria. Results: Eight children had closed reduction and percutaneous K-wire fixation. The other two children required open reduction through a posterior triceps splitting approach. The mean Baumann’s angle was 70.2° immediately after K-wires fixation and 69.5° after 3 months later. The mean lateral humerocapitellar angle was 38° immediately after K-wires fixation and 35.5° after 3 months later. The clinical outcome was excellent in nine children and poor in one child by the Flynn’s criteria. Conclusion: Reduction of displaced flexion-type pediatric supracondylar humeral fractures by traction and gradual extension in the prone position is an effective and safe method. When reduction is still impossible or nerve incarceration is suspected, open reduction and release of the trapped nerve through a posterior triceps splitting approach are simply accessible.