Objective: To investigate the causes and the measures for prevention and management of complications of supracondylar fracture of the humerus.
Methods: In 203 cases of supracondylar fracture of the humerus treated from July 2002 to July 2008, 49 cases had complication, whose data were retrospectively analyzed. There were 32 males and 17 females with an average age of 9 years (range 2-14 years). Fracture was caused by tumble in 38 cases, by falling from height in 4 cases, and by traffic accident in 7 cases. All cases were closed fractures. According to Gartland typing for supracondylar fracture of the humerus, there were 10 cases of type II and 39 cases of type III. Complications included 21 cases of vascular injuries, 10 cases of neural injuries, and 3 cases of osteofascial compartment syndrome. The time from injury to operation was 1-25 days. Closed reduction was given in 13 cases, closed reduction plus percutaneous K-wire fixation in 21 cases, and open reduction plus K-wire fixation in 15 cases. After reduction, plaster external fixation was performed. The cases of manipulation which blood circulation could not improve underwent incision to exploration of blood vessel. Two cases of neural injuries were treated with incision decompression of epineurium. Three cases of osteofascial compartment syndrome were treated with incision decompression, and the incision was sutured after 7-10 days.
Results: All incisions healed by first intention. The duration of follow-up was 1-5 years with an average of 3.4 years. Fracture healing was achieved within 4-8 weeks. All vascular injuries and 9 cases of neural injures recovered thoroughly. Poor function occurred in 1 case of median nerve injury and Volkmann ischemic contracture in 1 case of osteofascial compartment syndrome. Cubitus varus deformity was found in 11 cases and myositis ossificans in 4 cases within 3 months to 1 year. According to Flynn standard of the function of elbow, the results were excellent in 21 cases, good in 7 cases, fair in 3 cases, poor in 18 cases.
Conclusion: Early reduction is the key for prevention of further vascular injury, nerve injury and osteofascial compartment syndrome. Operation is essential when expectant treatment invalid. Satisfactory reduction, good fixation and functional rehabilitation are key points for preventing cubitus varus deformity.