The Journal of Bone and Joint Surgery (American). 2008;90:1690-1697.
doi:10.2106/JBJS.G.00528
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Lateral External Fixation—A New Surgical Technique for Displaced Unreducible Supracondylar Humeral Fractures in Children

Theddy Slongo, MD1, Timo Schmid, MD1, Kaye Wilkins, DVM, MD2 and Alexander Joeris, MD1

1 Department of Surgical Pediatrics, Children's Hospital, University of Berne, CH-3010 Berne, Switzerland. E-mail address for T. Slongo: theddy.slongo{at}insel.ch. E-mail address for T. Schmid: timo.schmid{at}insel.ch. E-mail address for A. Joeris: alexander.joeris{at}insel.ch
2 Department of Orthopedics and Pediatrics, University of Texas Health Science Center at San Antonio, 560 Grandview Avenue, San Antonio, TX 78209

Investigation performed at the Department of Surgical Pediatrics, Children's Hospital, University of Berne, Berne, Switzerland

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Percutaneous Kirschner wire fixation represents the classic treatment for displaced supracondylar humeral fractures in childhood. This type of treatment first requires satisfactory reduction of the fracture. Failure to achieve a satisfactory reduction or inadequate stabilization can result in instability of the fracture fragments, which can result in either an unsatisfactory cosmetic or functional outcome. In our experience, these problems can be overcome with the use of a small lateral external fixator.

Methods: Between 1999 and 2005, thirty-one of 170 Gartland type-III supracondylar humeral fractures were treated with a lateral external fixator. The outcome of treatment was analyzed with regard to limb alignment, elbow movement, cosmetic appearance, and patient satisfaction.

Results: In twenty-eight of the thirty-one patients, a satisfactory reduction was achieved with closed methods. All children except one had a normal or good range of movement. The cosmetic result was excellent in all cases. All of the children and their parents stated that they would choose this treatment again.

Conclusions: The use of a small lateral external fixator seems to be a safe alternative for the treatment of displaced supracondylar fractures of the humerus when a closed reduction appears to be unattainable by means of manipulation alone or when sufficient stability is not achieved with standard methods of Kirschner wire fixation.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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External Fixator for Supracondylar Fractures in Children: Is it Safe?
Rahij Anwar, et al.
JBJS Online, 20 Aug 2008 [Full text]