Prospective Longitudinal Evaluation of Elbow Motion Following Pediatric Supracondylar Humeral Fractures

Author(s): Spencer HT, Wong M, Fong YJ, Penman A and Silva M

Source: J Bone Joint Surg 92:904-10, 2010.

Summary:

This article reviews the range of motion of 373 patients whom sustained supracondylar humerus fractures.  Age, sex, side of injury, type of fracture, type of treatment, complications, and outcomes were all considered.  There were four groups of patients depending on the Gartland classification.  Gartland type I fractures (145 patients) were treated in a cast with about 100° of flexion.  There were 115 patients with Gartland type II fractures that could be reduced and casted.  The Gartland type II fractures that required surgery (81 patients) included patients where swelling precluded immediate circumferential casting, residual malrotation of the humerus or extension following closed reduction, or where fractures redisplaced at follow up.  The last group was Gartland type III fractures whom all required surgery.

Elbows were immobilized for an average of 4 weeks.  Pins/casts were then removed and range of motion was recorded.  Average ROM of all groups at cast removal was 66°.  The most rapid improvement in motion of all groups was at 9 weeks where the average ROM was 134°.  The more severe injury groups improved more slowly than the less severe groups, but all improved overall.  Improvement in ROM continued for up to 48 weeks.  Recovery was also slower in older patients (>5 years of age).  The authors conclude that the main factors in recovery of motion after supracondylar humerus fractures are age and severity of injury.