Prospective analysis of a new minimally invasive technique for paediatric Gartland type III supracondylar fracture of the humerus

Li, Yi-An; Lee, Pi-Chang; Chia, Wei-Tso; Lin, Huai-Jen; Chiu, Fang-Yao; Chen, Tain-Hsiung; Feng, Chi-Kuang

doi:10.1016/j.injury.2009.03.007

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Volume 40, Issue 12 , Pages 1302-1307, December 2009

Prospective analysis of a new minimally invasive technique for paediatric Gartland type III supracondylar fracture of the humerus☆

Yi-An Li
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
Wei-Tso Chia
- Department of Orthopedics, Hsin Chu General Hospital, Taiwan
Huai-Jen Lin
- Department of Orthopedics, Kuang Tien General Hospital, Taiwan
Fang-Yao Chiu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
Tain-Hsiung Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
Chi-Kuang Feng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
- Corresponding author at: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan. Tel.: +886 2 2875 7557; fax: +886 2 2875 7559.

Accepted 5 March 2009.

Abstract

Objective

The purpose of this study was to introduce a minimally invasive surgery using mosquito forceps for achieving the reduction of severely displaced supracondylar fracture of the humerus in children and evaluate the clinical outcome.

Materials and methods

Gartland type III supracondylar fractures of the humerus in children under the age of 12 were analysed from January 2000 to January 2007 at our institute. The control group cases were selected by successful reduction using the standard technique described by Rockwood and Wilkins (2001). The others composed the study group. This study included chart reviews, radiographic images of both the antero-posterior and the lateral views, physical examination, and Mayo elbow performance index scores preoperative, postoperative, and final follow-up.

Results

Evaluations were completed for 42 cases. The mean age was 6.9 years and the group consisted of 23 boys and 19 girls. The mean follow-up time was 34.5 months. Twenty-six cases were of injuries to the left side, and 16 were of injuries to the right. The Mayo elbow performance index score was excellent in both groups. Operation time in the control and study groups was 46 and 79min, respectively. There was one case of iatrogenic ulnar nerve injury each in the study and control group. One case of loss of reduction and another with a combination of ulnar nerve injury and loss of reduction were noted in the control group. All four cases had an excellent final outcome. No mosquito-forceps-related complication was found, and in the final follow-up, no cubitus varus was found.

Conclusion

Minimally invasive surgery with the assistance of mosquito forceps for the reduction of severely displaced supracondylar fracture of the humerus in children was shown to be a safe and effective alternative method. The final functional outcome was the same as that of the standard technique.

Keywords: Supracondylar fracture, Children, Humerus, Gartland type III, Minimally invasive, Prospective