Treatment of Delayed Supracondylar Humerus Fracture in Paediatric Patients with Closed Callostasis: Our Hospital Experience

Abstract

Introduction: Supracondylar fractures of humerus (SCHFs) are frequently encountered in children. Delayed presentation of such fractures is particularly common. The absence of established guidelines for managing late-presenting SCHFs poses a clinical challenge. Objective: This study aimed to evaluate delayed SCHFs treated by the closure of Callostasis and percutaneous fixation. Study design: prospective cohort study. Place and Duration: This study was conducted in Ghulam Muhammad Mahar Medical College Sukkur from May 2022 to May 2023. Methodology: Children having Type III Gartland SCHFs with a delay of ≥7 days were included in the study. Children having Fractures with neurovascular injuries or requiring ORIF were excluded. Patients received treatment involving closed reduction followed by percutaneous cross-wire fixation under fluoroscopic guidance. A careful closed Callostasis was used to avoid excessive force. In cases where closed reduction was infeasible, the procedure was converted to open reduction. After verification of optimal alignment and pin placement with C-arm imaging, protruding K-wire ends were bent and left external. A long-arm cast or splint was applied with the elbow flexed and the forearm supinated. Outcomes were assessed using humerocaptellar angle, Flynn's criteria, and Baumann's angle. Results: The study included 50 patients with a mean age of 6.5±2.8 years (range: 2-12 years). The average presentation delay was 12.8±4.6 days, and the mean postoperative follow-up spanned 14.2±3.6 months. At the one-year follow-up, 46 (92%) patients demonstrated full range of motion (ROM), while 4 (8%) patients exhibited deficient ROM in both flexion and extension, primarily due to non-compliance with the prescribed treatment regimen. Flynn's criteria indicated excellent outcomes in 72% of cases. Conclusion: Closed osteoclasis, reduction, and percutaneous pinning offer a viable and effective method for addressing delayed displaced SCHFs.