The Effects of Surgical Treatment on Elbow and Hand Functions in Gartland Type 3 Children’s Humerus Supracondylar Fractures with Posterior Approach

Aim: The aim of this study was to evaluate the effects of treatment with open surgery methods on elbow and hand functions in paediatric patients with a Gartland Type 3 humerus supracondylar fracture. Material and Method: The study comprised 25 patients (7 female, 18 male; mean age 6.7 years, range, 3-13 years) who were treated and regularly followed up at our clinic between 2005 and 2009. All the fractures were extension Type 3 according to the Gartland classification. All the patients were treated with posterior approach open reduction and internal fixation. 20 patients underwent surgery within the first 8 hours and 5 patients between 8-72 hours (mean 57.6 hours). In the postoperative follow-up, carrying angle, elbow range of movement, grip strength and pinch strength were measured with hand evaluation tests. Upper extremity functions were scored with the Q-DASH scoring system. The functional and cosmetic results were evaluated according to the Flynn criteria. Results: According to the Flynn criteria, 20 of the 25 patients had excellent results, 1 good, 3 fair and 1 poor. At the final follow-up examination, 6 patients (24%) had limited flexion of mean 3.9° (min 5°, max 25°). No restriction of extension was seen in any patient. While there was a loss of grip strength of mean 0.9kg (4%) compared with the healthy side, the loss of pinch strength was mean 0.05 kg (0.8%). Compared with the healthy side, 16 patients had a loss of carrying angle of mean 2.1° (min -10°, max 5°). Of these, the loss was valgus in 3 patients (mean 3.6°,min 3°%u2013max 5° ), and varus in 12 (mean 5.7°, min -10° %u2013 max -3°). In 10 patients no loss of carrying angle was determined. Discussion: Limited extension and triceps insufficiency which are the most significant disadvantages of the posterior approach were seen to have completely recovered at the final follow-up. Loss of carrying angle which develops following treatment of paediatric humerus supracondylar fractures did not affect the functional results to a significant degree