Oblique Supracondylar Humeral Fractures in Older Children

Background: Supracondylar humeral fractures in older children have different biomechanical characteristics and surgical outcomes than younger children. Previous studies have suggested that oblique fracture patterns have a negative impact on the fixation stability of displaced fractures, and that the Gartland classification failed to predict loss of reduction. We aimed to analyze the fracture architectures in a large group of older children and investigate the correlation between fracture patterns, fixation techniques and the rate of loss of reduction.

Methods: A retrospective review study was conducted. We collected the records of 240 consecutive patients aged 8-14 years that sustained Gartland type 2 or 3 supracondylar humeral fractures between 2004 and 2014 and were operated at our institute. Excluded patients included those with intraarticular fractures and pathological fractures. Following radiographical analysis and chart review we conducted a multivariable regression analysis that included patient, fracture and treatment variables.

Results: Fracture obliquity on the sagittal plane (>20°) occurred in 33% of the cases and was found to be the only factor related with loss of reduction (P=0.01). Gartland type 3 fractures and more than two lateral pin configuration did not correlate to fixation failure (P=0.69 and P-0.14, respectively). The incidence of flexion type fractures (5.8%) was found to be higher than in the total pediatric population.

Conclusions: The sagittal oblique supracondylar humeral fracture is common, and is related with fixation instability and loss of reduction. This pattern needs to be considered when investigating different pin configurations, complication rates and biomechanical properties. Sub classifying Gartland type 2/3 SCHFs as “oblique” or “transverse” might offer a more comprehensive information about the anticipated operative results and lead to improved outcomes following surgical fixation.