Outcomes of Surgical Treatment of Pediatric Supracondylar Humerus Fractures by Bilateral Triceps Approach


1 Orthopedic and Trauma Imam Reza Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Department of Orthopedic Surgery, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran



Background: Humerus supracondyllar fracture is one of the most common elbow injuries. Choice of treatment depends on grading of the displacement. Closed Reduction and pinning is the preferred method of treatment. Open reduction is indicated when we encounter neurovascular injury after closed reduction. One of the most important factors in the outcome of surgery is an appropriate approach that would provide better exposure with less soft tissue injury. Anterior, posterior, medial and lateral surgical approaches are used for this type of fracture. Objectives: Posterior bilateral triceps approach has less been studied so far. In this study we review the results of humerus supracondyllar fracture surgery by this approach. Patients and Methods: This study is a case series and includes 43 patients aged between 3.5-15 who referred to Imam Reza Hospital in Mashhad Iran from July 2006 to Octobre 2011 with humeral supracondylar fracture; Gartrland; type III. All patients had at least once, failed closed reduction. On admission, all patients with open fracture or neurovascular injury were excluded. All the patients were operated in one hospital and with the same method (bilateral triceps open reduction). Patients were followed up from 7 months to 2 years by the clinicians who were not involved in the selection of patients, the process of treatment and surgery. History, basic information, DASH questionnaire (disability of the arm and hand) physical clinical examination, particularly ROM (range of motion) and objective tests to measure muscular strength and radiographies were reviewed. Results: The mean age was 7.2 ± 2.4 years. The mechanisms of injuries were falling in 25 patients, skateboarding accident in 6 patients and 12 cases of motorized or non-motorized vehicle accidents. 8 patients required physiotherapy (maximum 20 sessions). Joint ROM in 91% of patients was complete. 4 patients (9%) had about 5-10 degree of limited range of extension (flexion deformity). The mean elbow flexion and extension strength in the injured hand was 80%-95% of the opposite one. No instability and laxity of the elbow joint was seen. The mean score of DASH was 30 ± 2.4. Reduction in the X-ray control after surgery was acceptable. No loss of reduction, nonunion and malunion, hardware failure, wound and infection complications, bleeding from the wound or hematoma formation at the site of surgery, neurological disorders after surgery and paresis were seen in postoperative examinations. Conclusions: By using Bilateral triceps approach for humerus supracondylar fracture, you can be able to have a very good exposure field as presented on pictures and due to less soft tissue damage in this approach, you need less immobilization time. After six weeks, the patient has full elbow range of motion, acceptable DASH score and no complication