Errors and complications in treating supracondylar fractures in children and adolescents

Background. The prevalence of distal humerus epimetaphysis fractures in children and adolescents in Ukraine is approximately 16.2 % of all upper limb injuries. The complications associated with these fractures can be classified into early ones, which are directly related to the trauma, repositioning, and fixation, and delayed complications, which are caused by loss of repositioning and manifested by angular varus or valgus deformities, ischemic contractures, neuropathy, and osteonecrosis. The purpose: to analyse treatment strategies in children and adolescents with supracondylar humerus fractures, to identify errors, complications and ways to solve them. Materials and methods. The material for the study was the results of examination and treatment of 175 patients (87 — main group, 88 — controls). The type of fracture was established according to the AO Pediatric Comprehensive Classification of Long-Bone Fractures. Results. Damage to nerve structures in supracondylar humerus fractures was detected in 6 patients (6.9 %) in the main group and 11 controls (12.5 %). Furthermore, it was found that damage to the anterior interosseous nerve was prevalent in extension fractures, occurring in 33.3 % of cases in the main group and 27.3 % in the control one. Ulnar neuropathy is most prevalent in flexion fractures: 66.6 % of cases in the main group and 36.4 % in the control group. Iatrogenic nerve damage was observed in 4.5 % of controls. Cubitus varus deformity as a result of insufficient repositioning or its loss during treatment was detected in 1.1 % of patients in the main group, while in the control group had a rate of 4.5 %. This complication was more often in patients with type II fractures to whom the orthopaedic trauma care was provided in the scope of closed reduction and plaster cast immobilisation. The relatively low proportion of varus deformity in the main group can be attributed to the increased use of percutaneous fixation of the fracture site with lateral configuration pins (78.3 % of cases). Conclusions. 1. Ulnar nerve damage caused by medial pin insertion was observed in 4.5 % of patients in the control group. Functional outcomes show that there is no significant difference between the two types of fixation — cross and lateral. However, the lateral type of stabilisation eliminates this complication. 2. Angular deformity due to insufficient repositioning or its loss requires correction and cannot be regarded as a cosmetic defect. The current trend of active use of percutaneous fixation in type II fractures is one of the ways to solve this urgent problem.