ENSAFDARAN A, EMAMI M, BORGHEI M. A COMPARATIVE STUDY OF LATERAL APPROACH VERSUS P OSTERIOR APPROACH FOR THE SURGICAL TRE ATMENT OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN. Med J Islam Repub Iran 2005; 19 (3) :213-217
URL:
http://mjiri.iums.ac.ir/article-1-574-en.html
Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, I.R. Iran , ensaf@yahoo.com
Abstract: (4585 Views)
Background: Supracondylar fracture of the humerus is the second most common
fracture in children. For most cases closed reduction and percutaneous crossed
pinning is recommended. Those patients who had previously undergone an unsuccessful
closed reduction trial need open reduction and pin fixation, but the best surgical
approach is questionable. Most surgeons apply the technique of posterior or lateral
approach.
Methods: To compare the results of these two classical techniques, in a prospective
study, 40 pure closed noncomplicated supracondylar fractures of the humerus
(under 10 years old ), after failure of closed reduction, were randomized into 2
groups, 20 cases in each series, and operated by a single surgeon. The first group was
operated by posterior approach. There were 12 boys and 8 girls, with average age of
5 years (range 3-10). Their fractures were reduced and fixed by two crossed pins. The
second group was operated by lateral approach. There were 14 boys and 6 girls, with
average age of 6 years (range 4-10), whose fractures were reduced and fixed by two
lateral pins. Both groups were immobilized in a long arm posterior slab in 80 degrees of
elbow flexion. The sutures were removed after 2 weeks, and the pins were removed
after 3 weeks and active motion begun. Then after 6 months follow up, the results were
determined according to Lagrange - Rigault range of motion.
Results: In group 1: 70% (14 patients) were excellent, 20% (4 patients) good,
10% (2 patients) poor results. In group 2: 85% (17 patients) were excellent, 15% (3
patients) good, and no poor or bad results. There was a significant difference between
groups 1 and 2 (p<0.05) for post-operation range of motion. There was no deep
infection, myositis ossificans or compartment syndrome.
Conclusion: The lateral approach appears to provide good long-term functional
results.