Supracondylar humerus fracture is a serious injury to the elbow in children and the most common childhood elbow fracture, accounting for approximately 50% to 70% of all elbow injuries, commonly occurring in children 3 to 10 years of age, and most commonly in boys 5 to 7 years of age. Supracondylar fractures of the humerus often occur on the nondominant side of the hand. Improper early management can lead to forearm osteofascial compartment syndrome and the formation of Volkmann contracture resulting in lifelong disability. Sun Jun, Department of Pediatric Orthopedics, Anhui Children’s Hospital
Supracondylar fractures of the humerus are treated with emphasis on early closed reduction. Since the fracture end bleeds and edema after the injury causing swelling of the limb, closed reduction is best performed within 6 hours after the injury. After this period, the swelling of the limb is obvious and even tension blisters appear, which affects the effect of the repositioning and can easily lead to infection. It is generally recommended to moderately immobilize and elevate the affected limb, and then perform closed repositioning after the swelling subsides, which is about 3-5 days.
In the past, closed repositioning was used, and only after successful repositioning with extreme flexion plaster fixation was it possible to maintain the repositioning, and often re-displacement occurred during or after the operation of plaster fixation, so the success rate was low and brought great confusion to the treatment. If surgical reduction is performed by incision, it will cause great pain to the child and is prone to complications such as vascular nerve damage and joint dysfunction, and the skin will leave permanent scars.
The application of closed reduction percutaneous pinning technique in children with supracondylar humerus fractures is a major advancement in treatment. The advantages of this method are: the pin is firmly fixed, in line with the requirements of minimally invasive surgery, avoiding the damage to soft tissues and affecting the joint function; the trauma is small, which can protect the local blood circulation and facilitate fracture healing; it is not easy to occur elbow inversion deformity; early functional exercise is possible; and the child suffers less pain and has a shorter hospital stay, which is a good method for treating pediatric supracondylar humerus fractures.
Our department treats hundreds of cases of supracondylar humerus fracture every year, and more than 90% of the children can be successfully repositioned with this technique and achieve good results.