The effect of position of anterior humeral line on elbow function after pediatric supracondylar fracture of humerus: A prospective observational study.

OBJECTIVE

To determine the influence of various Anterior humeral line (AHL) positions on elbow function after complete healing of pediatric supracondylar humerus fractures.

METHODS

A prospective study was carried out in 4-year to 14-year-old children presenting with supracondylar fracture at elbow. The intra and post-operative radiographs were assessed for the position of AHL to capitellum on a lateral radiograph. The fractures were categorized into five AHL positions. Radiographs were taken on follow-up visits, and the elbow function was assessed at the final follow-up utilizing elbow performance scores like Flynn's criteria and Mayo's performance score.

RESULTS

58 out of 62 patients (mean age of 8.2 ± 2.8 years) with complete follow-up of 18 months were evaluated and analyzed. The five groups of AHL demonstrated significant differences of arc of motion, mean loss of extension-flexion, and elbow function using Flynn's criteria with no significant difference in Mayo's elbow score. All cases of cubitus varus in the series exhibited alignment anterior and missing capitullum.

CONCLUSIONS

The radiological positions of AHL can predict the elbow function after surgery. Patients with AHL position crossing the anterior third of the capitellum have reduced arc of motion and risk developing cubitus varus in the future. Children with AHL position intersecting the posterior and middle third of capitellum have bilaterally comparable elbow flexion and total range of motion.