The recent lecture has been full of articles regarding Pediatric Supracondylar Fractures. The shear number of these fractures and the difficulty with reduction and postoperative monitoring remains a vexing problem. Most authors reduce and/or pin supracondylar fractures in the supine position. This report discusses reduction and fixation of pediatric supracondylar fractures in the prone position. The cited advantages are that gravity helps reduce the sagittal plane deformity and the arm hangs freely.
The authors spent a great deal of time discussing their technique. In summary, the arm is positioned over an arm board and the forearm and hand are allowed to hang freely. The C-Arm can be manipulated around the arm without difficulty, which facilitates assessment of fracture reduction. The authors prefer cross lateral and medial pins for Type II and Type III supracondylar fractures.
The cohort is large but extends across a long time period. There were a total of 455 patients over between the years 1989 and 2006. There were 246 Gartland Type II and 209 Gartland Type III fractures. The mean surgical time was 36 minutes on those that had the records available. The kirschner wires were removed at 6 weeks, and radiographs used to assess alignment.
Sixteen patients or 3.5% lost reduction. Similar to a previous report by Skaggs and colleagues, a review of these x-rays revealed incorrect or insufficient placement of kirschner wires. There were 6 pin tract infections that required oral antibiotics, but none required early extraction. Consistent good to excellent range of motion and outcome were obtained in these patients. There is a limited follow- up date available in the article.
The authors offer prone position as a method for fixation of displaced supracondylar fractures. The prone position does have advantages of allowing the arm to hang freely and easy C-Arm access. Rotation of the arm is not required for biplanar x-ray visualization, which is beneficial. The same risk of pin placement is present whether the patients are supine or prone. Disadvantages of this technique relate to placing the position prone and the difficulty if open reduction is necessary. For example, neurovascular exploration is much easier in the supine position.