TREATMENT AND OUTCOMES OF PEDIATRIC SUPRACONDYLAR HUMERAL FRACTURES IN KORLE-BU TEACHING HOSPITAL.

Abstract

BACKGROUND Supracondylar humeral fractures are the most common elbow fractures in the pediatric population. These normally result from either a fall on the outstretched hand or the flexed elbow resulting in either the extension or flexion types respectively. They are usually associated with complications such as neurovascular injuries, compartment syndrome, pin tract infections and malunion which in the end after the cosmetic and functional outcomes according to the Flynn’s criteria. The objective of this study was to determine the treatment and outcomes of pediatric supracondylar fractures of the distal humerus at Korle Bu Teaching hospital.

METHODOLOGY This was a prospective study carried out at the trauma and orthopedic unit of Korle Bu Teaching Hospital, Accra. Patients for this study were recruited over a year period from January 2014 to January 2015. An evaluation form was filled by the principal investigator and attached to patient’s folders. One hundred and one patients were entered into the study. Treatment of supracondylar humeral fractures in children were guided by the department’s protocol. Patients were followed up over a six (6) month period . Data collected during this period were entered into the REDCap data base, which is a secured web based data collection tool hosted by the University of California, San Francisco (UCSF). The results were then analysed using SPSS version 23.

RESULTS The mean age was 5.2 years with a peak of 4-5 years. There were seventy three (73) males and twenty eight (28) females with a ratio of 2.6:1. Most of the injuries occurred at home (64.3%) followed by at school (27.7%). The left arm (non-dominant) was the most injured (62%) compared to the right (38%), though most of the patients seen were right hand dominant (92%). Gartland type III (43.6%) was the commonest fracture followed by type I (31.7%) and type II (24.7%) respectively. Outcomes of management of these fractures were satisfactory based on Flynn’s criteria in over 95 % of the patients. The pediatric quality of life outcome was significantly affected at three weeks after the injury. However, they returned to the population normal at six month. Pin tract infections (5 patients), nerve injury (3 patient), vascular (1 patient), cubitus varus (1 patient), elbow stiffness (1 patient) and myositis ossificans (1 patient) were the complications observed in the study and were mostly associated with high energy injuries (type III fractures).

CONCLUSIONS Pediatric supracondylar humeral fractures are very common injuries and their diagnosis and treatment presents a major difficulty to us as orthopedic surgeons. However, through this study, it is concluded that the outcomes of treatment of these fractures at our institution is satisfactory and comparable to other places where they manage such fractures.