Supracondylar extension type III fracture of the humerus in children: percutaneous cross-pinning.

OBJECTIVE Supracondylar extension type III fractures in children are difficult to treat especially in maintaining reduction after closed manipulation, thereby increasing chances of complications. MATERIALS AND METHODS Forty consecutive patients with supracondylar extension type III fracture of the humerus attending Kathmandu Medical College Teaching Hospital (KMCTH) between July 2004 to December 2005, treated by closed manipulative reduction and percutaneous cross-pinning under general anaesthesia, were the subject of this prospective study. RESULTS There were 16 females and 24 males. The mean age of the patients was 6.5 years (2 to 12 years). Left side was injured in 27 patients and right side in 13. Patients were followed for a period of one year on average (6 to 18 months). Under general anaesthesia and C-arm image intensifier, closed manipulative reduction was performed. Two K-wires of size 1.6 to 2.0 mm were introduced from lateral and medial side in crossed fashion. Ulnar nerve was protected by pushing it posteriorly during medial pinning. Long arm plaster slab was applied post-operatively. Patients were discharged the next day of operation. Callus was visible in all patients on X-rays after 3 weeks. The long arm slab and K-wires were removed and active mobilization of the elbow joint was started. Fracture union was seen in all, 6 weeks post-operatively. At follow-up, range of motion of the elbow joint was 25 to 135 degrees after 6 weeks and 0 to 140 degrees after 3 months, which was similar to that of normal side. After 3 months of operation carrying angle was 8-10 degrees in all except in two cases (0 degrees). There were no neuro-vascular complications or cubitus varus deformity in any of the patients. CONCLUSION Percutaneous crossed K-wire pinning after closed manipulation in supracondylar extension type III fracture of the humerus is a reliable and safe method of treatment and is recommended in all.