title: Operative management of displaced flexion supracondylar humerus fractures in children.
abstract: Flexion-type supracondylar humerus fractures remain an uncommon variant of the common extension-type injury. They are often thought to be more difficult injuries, more probable to require open reduction, and have neurovascular complications. We reviewed the 10-year history of flexion-type supracondylar elbow fractures treated at 1 institution and compared these cases with those of an extension-type cohort collected during a similar period. The patients in the flexion-type group (mean age, 7.5 years) were significantly older than those in the extension-type group (mean age, 5.8 years). The fractures in flexion-type group were also more probable to require open reduction (31%) than those in the extension-type group (10%). There was no difference in the incidence of preoperative nerve symptoms; however, the flexion-type group had a significantly increased incidence rate of ulnar nerve symptoms (19% vs 3% in the extension-type group) and need for ulnar nerve decompression. The flexion-type variant should be recognized preoperatively, and the potential pitfalls involved with the treatment of these injuries appreciated.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital Boston, MA, USA. susan.mahan@childrens.harvard.edu
authors.forename: Susan T
authors.initials: ST
authors.lastname: Mahan
authors.forename: Craig D
authors.initials: CD
authors.lastname: May
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries*; D000092464:Elbow Injuries