title: The prognostic value of the fracture level in the treatment of Gartland type III supracondylar humeral fracture in children.
abstract: A small proportion of children with Gartland type III supracondylar humeral fracture (SCHF) experience troubling limited or delayed recovery after operative treatment. We hypothesised that the fracture level relative to the isthmus of the humerus would affect the outcome. We retrospectively reviewed 230 children who underwent closed reduction and percutaneous pinning (CRPP) for their Gartland type III SCHFs between March 2003 and December 2012. There were 144 boys and 86 girls, with the mean age of six years (1.1 to 15.2). The clinico-radiological characteristics and surgical outcomes (recovery of the elbow range of movement, post-operative angulation, and the final Flynn grade) were recorded. Multivariate analysis was employed to identify prognostic factors that influenced outcome, including fracture level. Multivariate analysis revealed that a fracture below the humeral isthmus was significantly associated with poor prognosis in terms of the range of elbow movement (p < 0.001), angulation (p = 0.001) and Flynn grade (p = 0.003). Age over ten years was also a poor prognostic factor for recovery of the range of elbow movement (p = 0.027). This is the first study demonstrating a subclassification system of Gartland III fractures with prognostic significance. This will guide surgeons in peri-operative planning and counselling as well as directing future research aimed at improving outcomes.
authors.affiliation: Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, South Korea.
authors.forename: S
authors.initials: S
authors.lastname: Kang
authors.affiliation: Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, South Korea.
authors.forename: M
authors.initials: M
authors.lastname: Kam
authors.affiliation: Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
authors.forename: F
authors.initials: F
authors.lastname: Miraj
authors.affiliation: Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, South Korea.
authors.forename: S-S
authors.initials: SS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000534:rehabilitation / Q000601:surgery*; D007223:Infant; D057072:Intra-Articular Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Children; Function; Prognosis; Range of movement; Supracondylar humeral fracture