Today's News

Saturday, March 3, 2001

2-12% of fractures not reducible by closed means

Recent literature supports closed reduction and percutaneous pinning as the treatment of choice for displaced supracondylar fractures, researchers said Thursday in scientific paper 133. However, they observe that 2 percent to 12 percent of fractures are irreducible by closed means.

The purpose of their study was to review a series of supracondylar humerus fractures that were managed with open reduction and internal fixation with pins to delineate our indications for open reduction, and to determine the outcome of such treatment.

They found that although their series represents the most severely displaced fractures, these results compare favorably with results reported for closed reduction and percutaneous pinning of unselected Gartland type III fractures.

Between January 1984 and July 1997, 862 supracondylar humerus fractures were treated; 792 were managed with closed means. Sixty-five patients were managed with open reduction and internal fixation with pins. Of the 65 elbows, 12 had vascular compromise, eight had open fractures, one had a postreduction nerve palsy associated with malreduction, and 44 fractures were irreducible.

According to Flynn's criteria, 18 (55 percent) elbows were rated excellent, eight (24 percent) were rated good, three (9 percent) were rated fair, and four (12 percent), were rated poor after an average of 5.8 months postinjury. Two complications were identified. One patient developed cubitus varus and underwent a distal humerus osteotomy. One patient developed a postoperatively ulnar nerve palsy that resolved following removal of the fixation pins. for closed reduction and percutaneous pinning of unselected Gartland type III fractures.

Richard Reitman, MD; Peter Waters, MD; and Michael Millis, MD, all of Childrens Hospital Boston, Mass., are the investigators.

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