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Nonoperative Treatment of Type IIA Supracondylar Humerus Fractures: Comparing 2 Modalities

Roberts, Lauren, MD*; Strelzow, Jason, MD*; Schaeffer, Emily K., PhD*,†; Reilly, Christopher W., MD, FRCSC*,†; Mulpuri, Kishore, MBBS, MS(Ortho), MHSc(Epi)*,†

doi: 10.1097/BPO.0000000000000863
Trauma

Background: Although the recommended treatment for Gartland types I and III supracondylar humeral fractures is well-established, the optimal treatment for type II fractures without rotational malalignment remains controversial, involving circumferential casting or closed reduction and pinning. Our institution uses pronated flexion-taping for Gartland type IIA fractures. This theoretically removes external pressure secondary to circumferential casting, potentially decreasing risks of compartment syndrome and mitigating loss of reduction with extension while maintaining optimal flexion position for reduction. To our knowledge, these modalities have not yet been compared.

Methods: A retrospective chart review was performed to compare flexion-taping with cuff-and-collar immobilization versus traditional above-elbow casting at 90 to 100 degrees. It was hypothesized that closed reduction and flexion-taping of type IIA supracondylar fractures under sedation in the emergency department would result in comparable, if not superior, maintenance of reduction measured radiographically using Baumann angle and the lateral humeral capitellar angle (LHCA). Charts from 2010 to 2015 were reviewed for all patients between 2 and 8 years of age with type IIA fractures treated with cast or taping.

Results: A total of 39 patients were included with 16 in the cast group and 23 in the tape group. Mean age was 4.08±1.72 years across both groups. No significant change in either measure was seen at termination of immobilization (3 to 4 wk postreduction). Final lateral humeral capitellar angle in the taping group was 32.14±5.90 degrees compared with 28.23±7.27 degrees in the casting group (P=0.81). Final Baumann angle was 73.41±4.03 degrees in the taping group compared with 73.75±6.46 degrees (P=0.96). The only complication was a self-limiting rash experienced by 1 patient in the taping group.

Conclusions: Both techniques were able to achieve and maintain adequate reduction in all cases with no significant difference in outcome measures. There were no major complications or conversions to surgical treatment. In this cohort, taping resulted in adequate reduction and safe immobilization for type IIA fractures comparable to cast immobilization. Further research will investigate clinical/radiographic outcomes on these patients to assess remodeling and function.

Level of Evidence: Level III—retrospective comparative study.

*Department of Orthopaedics, University of British Columbia

Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC

Disclosures of funding for this work: none.

The authors declare no conflicts of interest.

Reprints: Kishore Mulpuri, MBBS, MS(Ortho), MHSc(Epi), Department of Orthopaedic Surgery, BC Children’s Hospital, 1D69-4480 Oak St., Vancouver, BC, Canada V6H 3V4. E-mail: kmulpuri@cw.bc.ca.

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