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Operative Management of Displaced Flexion Supracondylar Humerus Fractures in Children

Mahan, Susan T. MD, MPH*†; May, Craig D.†; Kocher, Mininder S. MD, MPH‡

Journal of Pediatric Orthopaedics: July/August 2007 - Volume 27 - Issue 5 - pp 551-556
doi: 10.1097/01.bpb.0000279032.04892.6c
Trauma: Original Article

Flexion-type supracondylar humerus fractures remain an uncommon variant of the common extension-type injury. They are often thought to be more difficult injuries, more probable to require open reduction, and have neurovascular complications. We reviewed the 10-year history of flexion-type supracondylar elbow fractures treated at 1 institution and compared these cases with those of an extension-type cohort collected during a similar period. The patients in the flexion-type group (mean age, 7.5 years) were significantly older than those in the extension-type group (mean age, 5.8 years). The fractures in flexion-type group were also more probable to require open reduction (31%) than those in the extension-type group (10%). There was no difference in the incidence of preoperative nerve symptoms; however, the flexion-type group had a significantly increased incidence rate of ulnar nerve symptoms (19% vs 3% in the extension-type group) and need for ulnar nerve decompression. The flexion-type variant should be recognized preoperatively, and the potential pitfalls involved with the treatment of these injuries appreciated.

From the *Department of Orthopaedic Surgery, Children's Hospital Boston; †Orthopaedic Surgery, Harvard Medical School, and ‡Division of Sports Medicine, Department of Orthopaedic Surgery, Children's Hospital Boston, MA.

None of the authors received financial support for this study.

The author, Craig D. May, is a medical student at Harvard Medical School.

Reprints: Susan T. Mahan, MD, Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail susan.mahan@childrens.harvard.edu.

© 2007 Lippincott Williams & Wilkins, Inc.