Systematic percutaneous pinning of displaced extension-type supra-condylar fractures of the humerus in children: a prospective study of 67 patients

Extension supra-condylar fracture of the humerus is a most common fracture in children. Several treatment regimens have been used in the treatment of displaced supra-condylar humeral fractures. A prospective study was performed including 67 children presenting a displaced supra-condylar humeral fracture. We uniformly treated them by closed reduction under general anaesthesia with fluoroscopic control and two parallel lateral pinnings. The criteria for inclusion were a supra-condylar humeral fracture (Gartland type II and type III) with posterior displacement in an infant, or in an adolescent less than 16 years old. According to the Flynn classification, there were 47 excellent results (70%), 15 good (23%), two fair (3%) and three poor (4%), which means 62 good and excellent results (93%). This percentage fell to 61 and 27% respectively if we considered the humero-ulnar angle. Forearm prono-supination was always normal. Poor results analysis found no relation between them except for the type of the fracture. The humero-ulnar angle seemed to be the pejorative radiological criterion. There was no correlation between type of reduction in AP or lateral X-ray and functional or cosmetic results. Poor fracture reduction induced residual deformity; anatomic reduction is therefore necessary to avoid it.