Modern tactics of treatment for Gartland II supracondylar fractures of the humerus in children and adolescents: a literature review and meta-analysis

Background. Fractures of the distal epimetaphysis of the humerus account for 16 to 50 % of all bone fractures and 50–80 % of all intra-articular injuries of the upper limb in pediatric practice. Among the injuries of this location, supracondylar (3–18 %) and transcondylar fractures (57.5–70 %) predominate, mainly in children aged 4 to 9 years. The epidemiology of supracondylar fracture types according to the Gartland classification is as follows: I — 36.7 %; II — 26.2 %; III — 30.9 %; IV — 6.3 %. In the global orthopedic and traumatology practice, a certain consensus has been reached regarding the treatment of supracondylar fractures type I (external immobilization), type III–IV (closed/open reduction, internal fixation, external immobilization), but regarding type II, the question is actively discussed: is internal fixation necessary after closed reduction? The purpose was to determine the current treatment for Gartland II supracondylar fractures of the humerus in children and adolescents. Material and methods. The research methodology is based on the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. The search for literature sources was carried out using modern domestic and foreign databases, the depth of the search was the last 5–7 years using the follo­wing terms: distal humerus, supracondylar fractures Gartland II, pediatric patients, treatment. Results. According to the results of the analysis of literary sources, there is no consensus on the treatment of Gartland II fractures. Some authors characterize the surgical method of treatment as traditional; others claim the high effectiveness of conservative treatment based on their own clinical material. The point of view on the feasibility and effectiveness of both methods is significant. The authors justify the relevance of improving and objectifying the indications for their use, which will allow for the development of a coordinated treatment stra­tegy. Conclusions. Supracondylar fractures of the humerus in pediatric practice account for 3–18 %, mainly in children aged 4 to 9 years. In the global orthopedic and traumatology practice, the issue of treating Gartland II fractures, which occur in 26.2 % of cases, is actively discussed. A pressing issue today is the identification of risk factors that lead to complications, and indications for the use of a particular method, which requires further study.