Low incidence of flexion-type supracondylar humerus fractures but high rate of complications : a population-based study during 2000–2009
Kuoppala, Eira; Parviainen, Roope; Pokka, Tytti; Sirviö, Minna; Serlo, Willy; Sinikumpu, Juha-Jaakko (2016-05-11)
Eira Kuoppala, Roope Parviainen, Tytti Pokka, Minna Sirviö, Willy Serlo & Juha-Jaakko Sinikumpu (2016) Low incidence of flexion-type supracondylar humerus fractures but high rate of complications, Acta Orthopaedica, 87:4, 406-411, DOI:10.1080/17453674.2016.1176825
© 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0)
Background and purpose: Supracondylar humerus fractures are the most common type of elbow fracture in children. A small proportion of them are flexion-type fractures. We analyzed their current incidence, injury history, clinical and radiographic findings, treatment, and outcomes.
Patients and methods: We performed a population-based study, including all children <16 years of age. Radiographs were re-analyzed to include only flexion-type supracondylar fractures. Medical records were reviewed and outcomes were evaluated at a mean of 9 years after the injury. In addition, we performed a systematic literature review of all papers published on the topic since 1990 and compared the results with the findings of the current study.
Results: During the study period, the rate of flexion-type fractures was 1.2% (7 out of 606 supracondylar humeral fractures). The mean annual incidence was 0.8 per 105. 4 fractures were multidirectionally unstable, according to the Gartland-Wilkins classification. All but 1 were operatively treated. Reduced range of motion, changed carrying angle, and ulnar nerve irritation were the most frequent short-term complications. Finally, in the long-term follow-up, mean carrying angle was 50% more in injured elbows (21°) than in uninjured elbows (14°). 4 patients of the 7 achieved a satisfactory long-term outcome according to Flynn’s criteria.
Interpretation: Supracondylar humeral flexion-type fractures are rare. They are usually severe injuries, often resulting in short-term and long-term complications regardless of the original surgical fixation used.
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