TITLE:
Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture
AUTHORS:
Rebar Muhammad Noori Fatah, Bakhtyar Rasul M. Amin, Hamid Ahmad Mahmud, Ammar Jamil Yusif
KEYWORDS:
Supracondylar Fracture, Anterior Henry Approach, Posterior Campbell Approach
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.6 No.5,
May
24,
2016
ABSTRACT: Background: Supracondylar fractures of the humerus are among the most common type
of pediatric fractures. The outcome of severely displaced supracondylar
fracture of the humerus in children subjected to wide controversies in term of
safety, functional and cosmetic outcome. Closed reduction and percutaneous
pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where
intraoperative imaging is not available, in comminuted lateral column
fractures and uneducable fractures. Aim of the Study: To compare the
outcome (functional and cosmetic) of anterior (Henry) approach with the
posterior (Campbell) approach used in two groups of patients’ sustained displaced
supracondylar fractures. Patients and Methods: This prospective
study was performed on 48 pediatric patients who were been admitted to the
Emergency Hospital in Sulaimani province sustained displaced supracondylar
humeral fractures and treated during the period from the first of October 2009
to the thirty-one of January 2011. The study included 28 boys, 20 girls; their
mean age was 7.5 years; their ages range 2 - 13 years. We used the modified
Gartland classification to assess the fractures displacement and only Gartland
type II B and III were included and managed operatively by open reduction and
internal fixation with 2 crossed K-wires. Follow up continued for 6 months and
the results finally assessed using Flynn’s criteria. Results: According
to the criteria of Flynn et al., 20 patients (83.3%) treated by the
anterior approach had excellent functional results while 4 patients (16.7%) had
good functional results. While those treated by the posterior approach, 16
patients (66.6%) had excellent functional results, 6 patients (25%) had good results
and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22
patients in the anterior approach group and 20 patients in the posterior
approach group. Conclusion: Posterior Campbell approach is simpler than
anterior Henry approach, but it creates additional soft tissue damage that can
affect the circulatory status and hence possible osteonecrosis of the trochlea
and a higher percentage of limitation in joint mobility. While the anterior
approach is technically more demanding, but it gives better functional results.