functional outcome of supracondylar fractures in children

Supracondylar fractures of the humerus are among the most common fractures in
children. The vast majority of these fractures occur from a fall on the
outstretched hand with the elbow in full extension. Supracondylar
humerusfracturen are classified according to Gartland:
Gartland type I, non displaced fracture,
Gartland type II; geanguleerde fracture with intact dorsal cortex,
Gartland type III displaced fracture without cortical contact.
Type I fractures are typically treated with a circular upper arm cast at 90 °
for 3 to 4 weeks. There is no consensus on treatment of Gartland type 2
fractures: these fractures can be treated with plaster or closed (or open if
necessary) reduction and K-wire fixation followed by cast in 90°. The K-wires
can be placed parallel or crossed. In the literature, there is discussion
whether surgical treatment of type II fractures should be limited to type II-B
fractures. Due to the lack of consensus there is variation in the treatment of
type II fractures. Type III fractures are usually treated surgically. The
quality and stability of the repositioning is of importance for the functional
outcome. The main complication of a supracondylar humerus fracture if not
adequately treated is a cubitus varus with a permanent extension limitation. If
this occurs only surgically repair is a treatment option. The results of this
procedure are highly variable. Other functional outcomes after treatment of
these fractures in children are not well known. In daily practice, a permanent
functional limitation is often seen during outpatient follow-up after this type
of fracture. At present it is not apparent from the literature what percentage
of children suffer from permanent functional impairment and what is the degree
of impairment.

The aim of our study is to determine the functional outcomes in children after
a supracondylar humerus fracture and comparing the outcomes of various
treatment strategies.

In this observational study the long-term outcomes after treatment of
supracondylar humeral fractures in children are evaluated in a retrospective
cohort of patients who were treated in the LUMC, Juliana Kinderziekenhuis,
Groene Hart Ziekenhuis and en MC Haaglanden in the period 2002-2011 . In this
study, the outcomes (elbow function and complications) in the long term of the
different treatments of supracondylar humeral fractures in children are
studied. Following the data obtained an insight can be given into the treatment
strategies and potential for further investigation can be determined.

The patients are invited for a one-time visit to the outpatient clinic. During
the visit, the elbow function is tested and patients will fill out a
questionnaire. The functional test is without risk and painless.