Supracondylar Humerus Fractures: Classification Based Treatment Algorithms
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Supracondylar Humerus Fractures: Classification Based Treatment Algorithms Mudit Shah1 · Mandar Vikas Agashe1 Received: 22 August 2020 / Accepted: 3 October 2020 © Indian Orthopaedics Association 2020
Abstract Supracondylar humerus fractures are the most common fractures around the elbow in children between 4 and 10 years of age. The treatment of supracondylar humerus fractures can vary from conservative treatment to operative treatment depending on the fracture type. All around the world, the most commonly used classification system is the Wilkins-modified Gartland classification of supracondylar humerus fractures. Currently, the decision to operate or conserve the fracture is taken on basis of this classification system. Non-operative treatment for type I fractures and operative treatment for type III fractures have been well-established in literature. The management of type II supracondylar humerus fracture creates confusion in the minds of numerous orthopaedic surgeons around the world. We have tried addressing this using a classification-based treatment algorithm. Other classification systems like the AO classification, Lagrange and Rigault classification and Bahk classification with special reference to special fracture patterns that require attention and pre-op planning have also been mentioned. It is important to understand that operative management of each supracondylar humerus fracture is unique as regards fixation method and it is important to consider the fracture pattern before internal fixation. Keywords Classification · Supracondylar humerus fracture · Fracture pattern · Treatment algorithm
Introduction Supracondylar fractures of the humerus (SCH) are widely regarded as the most common fractures around the elbow of a child, and account for around 50–70% of all paediatric elbow fractures [1, 2]. After an elbow injury, these fractures account for about two-thirds of in-patient admissions in children that require surgery [3]. This fracture typically occurs in children between 4 and 10 years of age and is a potential cause of significant morbidity and deformity in the acute and chronic setting respectively [3–5]. Supracondylar fractures are generally of two types: the much commoner extension type fracture accounting for around 97% of all SCH fractures while the less common
* Mandar Vikas Agashe [email protected] Mudit Shah [email protected] 1
Dr. Agashe’s Maternity and Surgical Nursing Home, Vrindavan Building, Junction of LBS Marg, Andheri‑Kurla Rd, Wadia Colony, Kurla, Mumbai 400070, India
flexion type supracondylar fractures account for only 3–4% [5–7]. Supracondylar humerus fractures are known to have a potential to cause significant acute morbidity and complications such as nerve injuries, compartment syndrome and vascular injuries [5]. In the chronic setting, there is a chance of rotational and varus malalignment leading to mal-union and cubitus varus deformity which has its own set of functional and cosmetic issues [8]. Currently the modified Gartland classifi
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