title: Low incidence of flexion-type supracondylar humerus fractures but high rate of complications.
abstract: Background and purpose - Supracondylar humerus fractures are the most common type of elbow fracture in children. A small proportion of them are flexion-type fractures. We analyzed their current incidence, injury history, clinical and radiographic findings, treatment, and outcomes. Patients and methods - We performed a population-based study, including all children <16 years of age. Radiographs were re-analyzed to include only flexion-type supracondylar fractures. Medical records were reviewed and outcomes were evaluated at a mean of 9 years after the injury. In addition, we performed a systematic literature review of all papers published on the topic since 1990 and compared the results with the findings of the current study. Results - During the study period, the rate of flexion-type fractures was 1.2% (7 out of 606 supracondylar humeral fractures). The mean annual incidence was 0.8 per 105. 4 fractures were multidirectionally unstable, according to the Gartland-Wilkins classification. All but 1 were operatively treated. Reduced range of motion, changed carrying angle, and ulnar nerve irritation were the most frequent short-term complications. Finally, in the long-term follow-up, mean carrying angle was 50% more in injured elbows (21°) than in uninjured elbows (14°). 4 patients of the 7 achieved a satisfactory long-term outcome according to Flynn's criteria. Interpretation - Supracondylar humeral flexion-type fractures are rare. They are usually severe injuries, often resulting in short-term and long-term complications regardless of the original surgical fixation used.
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Eira
authors.initials: E
authors.lastname: Kuoppala
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Roope
authors.initials: R
authors.lastname: Parviainen
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Tytti
authors.initials: T
authors.lastname: Pokka
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Sirviö
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Willy
authors.initials: W
authors.lastname: Serlo
authors.affiliation: a Department of Children and Adolescents, Pediatric Surgery and Orthopedics , Oulu University Hospital, Medical Research Center Oulu, Oulu University, PEDEGO Research Group , Finland.
authors.forename: Juha-Jaakko
authors.initials: JJ
authors.lastname: Sinikumpu
mesh_terms: D000293:Adolescent; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005544:Forecasting; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries