Triceps-sparing Posterior Approach for Supracondylar Fractures in Children

Background: The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% ofelbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation oftype III supracondylar humeral fractures using a Triceps sparing posterior approach.Methods: In total, 98 patients were evaluated from June 2007 to 2014.Results: According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and theright to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which wasright. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internalfixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° andthe obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determinedat 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopicossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nervepalsy, two of which happened before surgery, and the other two following the surgery. All of these complications wereresolved within 3 to 10 weeks spontaneously.Conclusion: This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptableskin scar esthetically along with satisfactory postoperative function.Level of evidence: IV