Vol. 10, Issue 2 (2024)

Introduction: Supracondylar humerus fractures (SCH) in children, often occurring at ages 5 to 6, necessitate treatment due to associated soft tissue and neurovascular injuries.

Method: Between June 2020 and January 2023, 44 patients with type III supracondylar humerus (SCH) fractures were seen in our emergency room. Complications such as skin blisters, compartment syndrome, and brachial artery injury were observed, leading to exclusions from the study. Thirty-six consecutive patients treated with open reduction percutaneous pinning (ORPP) via a lateral approach were retrospectively included. They comprised 28 boys and 8 girls, with an average age of 7.5 years. Postoperative assessment involved monitoring cases with pink, pulseless hands and managing associated fractures, such as ipsilateral femoral shaft and distal radius fractures. Evaluation criteria included Baumann's angle and capitellum alignment with the anterior humeral line, along with Flynn grading for treatment outcomes.

Results: Pre-operatively, 4 (11.11%) anterior interosseous nerve (AIN) injuries were observed, presenting with a pointing index finger, resolving within 6 weeks post-injury. The average duration from emergency presentation to surgery was 8 hours (range, 4-15 hours), with surgery lasting 45 minutes on average (range, 37-55 minutes). Follow-up averaged 12 months (range, 6-15 months), with union achieved in 6.5 weeks on average (range 6 to 8 weeks). Baumann angle difference averaged 4.5° at final follow-up, with one patient exceeding a 15° difference. Notably, 3 patients experienced over a 15° difference in range of motion compared to the non-injured extremity. Outcomes were generally favorable, with 26 patients showing excellent results, 4 good, 3 fair, and 3 poor. Despite variations in range of motion, outcomes were satisfactory, demonstrating the efficacy of ORPP without image intensifier, which not only facilitated clinical and radiological healing but also mitigated radiation exposure and saved time.

Conclusion: Open reduction and percutaneous pinning is a safe and effective procedure to treat supracondylar humerus fractures in children and can be done without C-arm with fairly good accuracy.