title: Approach to supracondylar humerus fractures with neurovascular compromise in children.
abstract: OBJECTIVE
  The aim of this study was to evaluate neurovascular compromise in childhood Gartland Type 3 supracondylar humerus fractures (SHFs), identify the factors correlated with increased need of open reduction and compare the clinical outcome of anterior open reduction with that of closed reduction.
  
  
  METHODS
  The study included 65 patients (46 male, 19 female; mean age: 7.03 years, range: 1 to 14 years) treated surgically for SCH fracture between January 2002 and June 2008. Fractures underwent closed reduction with percutaneous pinning when possible. Open reduction was performed when adequate reduction via the closed technique failed or vascular compromise were indications for open reduction. Patient demographics, physical examination findings, adequacy of reduction, functional and cosmetic outcomes were assessed.
  
  
  RESULTS
  During the antecubital approach, vascular pathology was noted in all patients with signs of vascular compromise at physical examination. Half of these patients underwent vascular intervention. Closed reduction failed in 93% of patients with concomitant edema, ecchymosis and dimple sign. Of these, the median nerve was trapped between the bone fragments in 4 patients with normal neurological examinations. Functional and cosmetic results of open reduction were similar to closed reduction (p>0.05).
  
  
  CONCLUSIONS
  Closed reduction should not be forced in cases with marked edema, ecchymosis, dimple sign, and absence of radial pulse. The anterior approach is the surgical approach of choice due to direct visualization of neurovascular bundle and availability of neurovascular intervention by extending the same approach.
authors.affiliation: Department of Orthopedics and Traumatology, Yüksek İhtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Aksakal
authors.forename: Cenk
authors.initials: C
authors.lastname: Ermutlu
authors.forename: Bartu
authors.initials: B
authors.lastname: Sarısözen
authors.forename: Burak
authors.initials: B
authors.lastname: Akesen
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery*; D007223:Infant; D008297:Male; D008475:Median Nerve / Q000293:injuries; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology / Q000517:prevention & control*