European Journal of Cardiovascular Medicine

Supracondylar fractures are the most common elbow fracture recorded in children, accounting for approximately 60% of fractures around the elbow and 13-15% of all pediatric fractures ^[1]. These fractures are prevalent in the non-dominant hand between the ages of 5 and 8, with boys being more afflicted than girls ^[2-4]. These fractures are categorised into three categories according to their displacement. The fragmented portion is not displaced in type I, displaced with intact posterior cortex in type II, entirely displaced in type III, and completely displaced with periosteal stripping in type IV ^[5].

Complications arise as a result of intrinsic fracture instability, proximity to the brachial artery, three major nerves of the upper extremity, inadequate radiographs, poor interpretation of reduction and modality of maintenance of reduction, and, finally, patient compliance with therapy. The treatment goal for displaced supracondylar humerus fractures in children is anatomic reduction. Open reduction is recommended if closed reduction cannot achieve the desired anatomic reduction. This can be done without increasing the risk of problems.Fractures that do not respond to closed reduction are surgically treated with open reduction and pinning. Open reduction can be performed using anterior, posterior, medial, or lateral surgical techniques ^[6].

Supracondylar fracture of the humerus is one of the rare fractures that, when treated appropriately, may not throw the surgeon's reputation into question. Still, when treated incorrectly, it will undoubtedly bring shame to even the most well-known surgeon.

There is little debate on how to manage an undisplaced or slightly displaced fracture, however, there are several options for treating a completely displaced fracture. Others have developed blind pining following reduction or pinning under X-ray control. Some even advise accepting an inadequate closed reduction and performing an osteotomy to fix the deformity later. However, severe treatment, including surgery management, is frequently indicated in the elbow region. It is no longer true that a supracondylar fracture is not bad.

To evaluate the Functional outcome of type 3 supracondylar fracture of the humerus in children treated by open reduction and internal fixation by k-wires.

Study Design: Hospital-based prospective study.

Study area: The study was conducted in the Department of Orthopaedics.

Study Period:  February 2024 to July 2024.

Study population: All the children with Gartland type III fracture who presented to the orthopaedic outpatient or casualty.

Sample size: The study consisted of a total of 20 subjects.

Sampling Technique:  Simple Random technique.

Inclusion Criteria:

1. Age between five to twelve years.
2. No previous fracture in the same elbow.
3. Simple type 3 supracondylar humerus fracture.

Exclusion criteria:

1. Age less than five years and more than twelve years.
2. Open fractures.
3. Surgically unfit patients.

Ethical consideration: Institutional Ethical committee permission was taken before the commencement of the study.

Study tools and Data collection procedure:

A detailed history of the mode of injury was obtained from the parents as well as the patient. Out of the twenty cases, eight patients (40%) sustained fractures due to a fall while playing and the remaining twelve patients due to a fall from the cycle. Most of the cases had a history of falling on outstretched hands. All patients presented with pain, swelling, “S” shaped deformity of the lower arm and inability to move the affected elbow. On examination, all patients had diffuse swelling all around the elbow and puckering of the skin was seen at the site of fracture in 4 cases. All patients had shortening of the arm as compared to the normal side. The average period from injury to presentation was ten hours, the mean age being 8.8 years. There were 16 boys and 4 girls. 14 patients presented with involvement onthe left side and 6 patients on the right side.

Associated injuries included:

• Median nerve injury in 2 cases. These were traumatic neuropraxia and recovered completely in 10-12 weeks.
• Vascular Injury: In 3 patients the radial pulse was feeble, but the patient was able to move his fingers feebly and the character of the pulse became normal after open reduction and internal fixation with K-wires.
• X-ray of the elbow was taken in 2 planes anteroposterior& lateral. 20 cases of Gartland’s Grade III type of supracondylar fractures were included in the series. These were further grouped into #s with postero medial, postero lateral & posterior displacement.
• Out of these 20 cases, 6 had posterior-medial, eleven had posterior-lateral, 2 had posterior displacement, one case was of flexion type
• Out of twenty cases, 5 were given one trial and 2 cases were given two trials of closed reduction under sedation, taking care to maintain good radial artery pulsation.
• In 3 cases the radial artery pulsation had to be restored by open reduction and internal fixation.
• Check X-ray of the patients who underwent closed reduction was taken. They proved unsatisfactory and admitted for open reduction & internal fixation reasons.
• There was no re-establishment of the shaft condylar angle to at least 20 degrees.
• There was rotation in the horizontal plane (crescent sign).
• Inability to restore the radial pulse by closed reduction.
• Irreducibility secondary to soft tissue interposition i.e. periosteum and capsule.

The remaining thirteen cases were taken up for primary open reduction and internal fixation, the reasons being.

• Extensive separation of the fracture fragments.
• Severe vascular compromises even at the slightest attempt of manipulation.
• Routine blood investigations and urine examinations were done on admission. Injection tetvacand injection ciprofloxacin I.V. were given preoperatively.
• The average range of period from injury to surgery was 24-36 hours.

Collected data entered in the Microsoft Excel sheet. Data analysis was done by SPSS software Version 20. Continuous variables were categorised as either normal or abnormal and the patients in either category were reported as proportion. Pearson's chi-square test also known as the Chi-square test for independence and the Chi-square test of association was used to detect if there was any relationship between two categorical variables. ANOVA was used to compare the two means. A p-value of 0.05 is taken as significant.

TABLE 1: FLYNN’S CRITERIA

Failures:

1 case (6%) had poor results, which is considered as failure. This case had a limitation of elbow movement of more than 20O flexion, and cubitusvarus of 20O, associated with medial pillar comminution.

Table 2: Type of Displaced Fractures

Table 3: Type of displacement