A PROSPECTIVE COHORT ANALYSIS OF TWO NONOPERATIVE TREATMENT MODALITIES FOR THE MANAGEMENT OF PAEDIATRIC TYPE II SUPRACONDYLAR HUMERUS FRACTURES

Management of pediatric Gartland Type II extension supracondylar humerus (SCH) fractures has historically exhibited treatment variation. Our previous retrospective review of nonoperative management of Type II SCH fractures found both casting and flexion-taping achieved and maintained adequate reduction. Here we present the results of a prospective cohort of non-operatively managed Type II SCH fractures, examining whether there is a clinically significant difference in functional and radiographic outcomes between these two non-operative modalities. Patients 2-12 years old who were managed nonoperatively for a Type II SCH fracture and presented within eight weeks of injury at our center were enrolled. Demographic data collected included age, sex, and side of injury. Treatment data collected included non-operative method, need for reduction, changes in treatment, and complications. Radiographic parameters included the Lateral Humeral Capitellar Angle (LHCA), Baumann's angle, and adequacy of reduction. The primary outcome was change in LHCA and functional measurements included range of motion, Flynn's criteria, and QuickDASH. Secondary outcomes included the Pediatric Outcomes Data Collection Instrument (PODCI). In total, 135 patients had at least three months of follow-up with sufficient documentation, with 90 receiving casting and 45 receiving taping. The demographics were similar between groups. Three patients in the casting group were converted to operative management. No patients received operative management in the taping group, but three were converted to casting. Complications were slightly higher in the casting group compared to the taping group (13.3% vs. 11.1%). One patient in the taping group had AIN palsy at initial follow up. There was one patient in each group reporting significant loss of range of motion at longer term follow up. There was no statistically significant difference between the casting and taping groups for mean LHCA, Baumann's angle, QuickDASH score or Flynn's criteria. A slightly higher percentage of patients in the taping group was cleared for return to activity than the casting group at final follow-up. There was no significant difference between groups across all domains of the PODCI. These findings suggest there is no clinically significant difference between both radiographic and patient reported functional outcomes between the taping and casting groups in non-operatively managed Gartland type II supracondylar fractures. This is consistent with previous retrospective data and supports the use of flexion-taping as an alternative to cast treatment of Type II SCH fractures; especially considering the added benefit of easier removal which can decrease patient anxiety and discomfort.