Modified Pinning and External Tension Band Treatment of GartlandIII Kids’ Supracondylar Humerus Fracture

Objective: The purpose of this study is to retrospectively analyze the efficacy of modified cross pinning fixation and external tension band technique in the treatment of Gartland Type III supracondylar humerus fractures in children. Methods: From February 2008 to August 2011, 62 children suffered to GartlandIII kids’ supracondylar humerus fracture aged 7.1 (2.5 12) years were treated with open reduction through lateral approach and modified cross pinning fixation (cross pinning with lateral assisted pin) and lateral external tension band technique (lateral cross pins bent and ends hook mutually), of these 62 patients, 48 had sufficient clinical and radiographic follow-up to be included in our study. There were 35 boys and 13 girls, 6 cases were flexion type and 42 cases were extension type, 4 cases were open fractures and the others were closed. Left side was involved in 27 patients, the right side in 21. Twenty-seven closed fractures in the series had underwent failed closed reduction. The time from injury to operation was 2h-8d. The casts were removed then the patients were discharged one week post operation and began exercise at that time. The pins were removed 4 or 5 weeks’ post operation in most patients, if necessary, the pins were removed until 6th postoperative week in elder child. Results: The follow-up period varied from 15 to 29 months, with an average of 19.3 months. ROM of both elbows were measured at follow-up and the carrying angles were measured according to humeral-ulnar-wrist angle at late stage, the data of each side was compared. Flynn’s criteria was used to evaluate outcome of treatment. According to Flynn’s criteria, 45 cases got excellent result, 2 got good result and 1 got fair result. Conclusion: It is an ideal way to use modified cross pinning fixation and lateral external tension band technique to treat kids’ supracondylar fracture of the humerus. The firm fixation is beneficial for early activity for recovery, anatomical reduction and compression produced by lateral tension band were effective for avoidance of cubitus varus and other complications.