Outcomes of reduction more than 7 days after injury in supracondylar humeral fractures in children.

BACKGROUND

Some slightly extended type II fractures initially treated with closed reduction and casting can displace during the first 2 weeks of follow-up. Although closed reduction and percutaneous pinning are desirable for displaced supracondylar humeral fractures treated acutely, there is little or no available information regarding the surgeon's ability to obtain a satisfactory reduction when such a procedure is performed more than a week after the original injury, or the clinical outcome of it.

METHODS

We reviewed the information on 143 type II pediatric supracondylar humeral fractures that were treated by closed reduction and percutaneous pinning. To determine the effect of late treatment, we compared a group of fractures that was treated within the first 7 days (group 1, n=101) with a group that was treated >7 days after the injury (group 2, n=42).

RESULTS

Mean time from presentation to surgery was 2.1 days (range, 0 to 5) and 9.8 days (range, 7 to 15) for fractures in groups 1 and 2, respectively. There was no need for an open reduction in either group. An anatomic reduction was obtained in all fractures. There were no iatrogenic nerve injuries, vascular complications, or compartment syndromes in either group. Length of surgery was similar in both groups (P=0.3). There were no significant differences in final carrying angle (P=0.2) or range of motion of the treated elbow (P=0.21). Avascular necrosis of the humeral trochlea was identified in 2 fractures that were treated surgically 8 days after the original injury (group 2).

CONCLUSIONS

The results of this study suggest that it is possible to obtain an anatomic reduction of a type II pediatric supracondylar humeral fracture even after 7 days from the injury. Such a delay in surgery does not appear to lead to longer surgeries, a higher incidence of open reduction, or to alter the final alignment or range of motion of the elbow. However, the risk of developing an avascular necrosis of the humeral trochlea must be considered.

LEVEL OF EVIDENCE: II.