A COMPARATIVE STUDY OF LATERAL APPROACH VERSUS P OSTERIOR APPROACH FOR THE SURGICAL TRE ATMENT OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

Background: Supracondylar fracture of the humerus is the second most common fracture in children. For most cases closed reduction and percutaneous crossed pinning is recommended. Those patients who had previously undergone an unsuccessful closed reduction trial need open reduction and pin fixation, but the best surgical approach is questionable. Most surgeons apply the technique of posterior or lateral approach. Methods: To compare the results of these two classical techniques, in a prospective study, 40 pure closed noncomplicated supracondylar fractures of the humerus (under 10 years old ), after failure of closed reduction, were randomized into 2 groups, 20 cases in each series, and operated by a single surgeon. The first group was operated by posterior approach. There were 12 boys and 8 girls, with average age of 5 years (range 3-10). Their fractures were reduced and fixed by two crossed pins. The second group was operated by lateral approach. There were 14 boys and 6 girls, with average age of 6 years (range 4-10), whose fractures were reduced and fixed by two lateral pins. Both groups were immobilized in a long arm posterior slab in 80 degrees of elbow flexion. The sutures were removed after 2 weeks, and the pins were removed after 3 weeks and active motion begun. Then after 6 months follow up, the results were determined according to Lagrange - Rigault range of motion. Results: In group 1: 70% (14 patients) were excellent, 20% (4 patients) good, 10% (2 patients) poor results. In group 2: 85% (17 patients) were excellent, 15% (3 patients) good, and no poor or bad results. There was a significant difference between groups 1 and 2 (p<0.05) for post-operation range of motion. There was no deep infection, myositis ossificans or compartment syndrome. Conclusion: The lateral approach appears to provide good long-term functional results.