Possible Benefits of Treating Pediatric Complex Humeral Supracondylar Fracture with a Linear External Fixator

Background: Supracondylar humeral fractures are among the most common pediatric fractures and the most common fractures treated surgically. Treatment varies from simple casting to open surgical reduction and fixation, compatible with the Gartland classification. Slongo et-al have described in 2008 a new technique using a linear external fixator as an alternative method for failed close reduction.

Methods: We have followed 21 patients, aged 7.7 years on average, who were operated in our department between the years 2010-2016. All had suffered from supracondylar fracture graded Gartland 3 or 4. Closed reduction failed with all, and they were treated with either open reduction (n=11) or by using Slongo’s method (n=10). We examined retrospectively the long term outcomes of both groups using physical examination, serial x-rays and a modified DASH score questionnaire.

Results: Of all the patients 15 were males (71%), 8 of them (80%) in the external fixation group. 7 (33%) had right side fracture and 2 (22%) in the external fixation group. 5 patients (45%) had extension type fracture in the open reduction group compared to 4 (36%) in the second group. Neither neurovascular deficit nor infection was observed. Modified-DASH score averaged 0.25 in the external fixator group compared to 1.67. 4 patients (36%) in the open reduction group had remarkable hypertrophied scars. Flexion and extension were statistically similar with near optimal range in both groups (138 and 137 degrees respectively). Average carrying angle was 6° valgus in open reduction group compared to 3.3° in the second group. Bowman’s angle averaged 68.5° and 75.4° respectively.

Conclusion: Treating high grade supracondylar humeral fractures, especially flexion type and Gartland grade 4 using Slongo’s technique shows equivalent results to the classic open reduction technique and should be considered as an appropriate alternative method of treatment when closed reduction has failed.