Extension Type III Supracondylar Fractures are the most common fractures about the elbow in children. The injuries have received a lot of attention recently with a focus on pin fixation and complication rate. Anatomic reduction with stable fixation is the treatment of choice although some fractures are extremely difficult to reduce. If adequate closed reduction cannot be obtained, open reduction and internal fixation is recommended. There are a variety of approaches to obtain open reduction including lateral, medial, anterior, and posterior. In this study, the authors compare the results of close reduction and pin fixation vs. open reduction via posterior approach and pin fixation.
The initial cohort consisted of 83 patients with Gartland type III fractures. Due to a variety of reasons, the final cohort was 55 patients with a median follow-up of almost 2 years. Thirty-two fractures were managed with closed reduction and 22 patients were managed with open reduction. Both groups underwent percutaneous pinning. The demographics were similar in both groups. Outcome measures included radiographic and clinical parameters.
Preoperatively, there were several few nerve palsies that all resolved within 6 weeks. The fractures treated with close reduction healed in a slightly shorter time then those treated with open reduction. Functional and cosmetic results were much less in the open reduction group. Poor functional outcomes were related to diminished motion and scar formation. In the closed reduction group, 91% of the patients had a good functional outcome. In contrast, in the open reduction group, only 52% had a good or excellent outcome.
This article attempts to compare and contrast closed reduction and pin fixation vs. open reduction and pin fixation via posterior approach. As one would aspect, the time to union was slightly delayed in the open reduction cohort. However, the ultimate union was similar. A considerable confounding factor is that the majority of patients that required open reduction were done in a period of time when there was no fluoroscopy in the operating room. Certainly, many of these fractures would have been reducible and therefore amendable to close reduction and pinning. Regarding open reduction, there are a variety techniques. Most upper extremity surgeons tend to approach the elbow from an anterior approach, which is smaller and heals better. Therefore, one cannot extrapolate these results to include open reduction via an anterior approach. A take home message is that one should expect diminished results when a supracondylar fracture requires open reduction via posterior approach.