The long-term outcome of childhood supracondylar humeral fractures: A population-based follow up study with a minimum follow up of ten years and normal matched comparisons.
OBJECTIVE
We present the clinical and radiographic outcome of 81 children with Gartland type I to III supracondylar humeral fractures at a minimum follow-up of ten years (mean 12.1 years; 10.3 to 16.1) following injury.


METHODS
The clinical and functional outcomes are compared with normal age- and gender-matched individuals. The population-based study setting was first identified from the institutional registries; the rate of participation was 76%. Controls were randomly selected from Finnish National Population Registry.


RESULTS
According to Flynn's criteria, most fractures (75.3%) resulted in a satisfactory ("good or excellent") outcome. Satisfactory recovery was achieved in 75.0% of type I fractures treated by closed splinting (p = 0.013). Type II fractures were associated with both satisfactory (57.7%) and unsatisfactory (42.3%) results, regardless of the type of treatment, although the numbers were small in the sub groups. Most type III fractures were treated operatively, and most (76%) had a satisfactory outcome according to Flynn's criteria (p = 0.015). Compared with none among the normal subjects, flexion of the elbow was reduced by > 10° at long-term follow-up in 20 cases (24.7%, p < 0.001) and 9 (11.1%) had a reduced flexion of > 15° (p = 0.004). In patients who had sustained a type III fracture, the carrying angle was decreased by 35.7% (from 9.8° to 6.3°; p = 0.048). All patients achieved an excellent Mayo Elbow Performance Score (mean 96.4 points).


CONCLUSIONS
The long-term outcome of extension-type supracondylar humeral fractures is generally good, but not exclusively benign, with the potential for long-term pain and ulnar nerve sensitivity, and a decrease in grip strength and range of movement in type II and type III fractures. Bony remodelling cannot be relied upon to correct any residual deformity. In particular, type II fractures have impaired long-term recovery and justify individual consideration in their treatment. Cite this article: Bone Joint J 2016;98-B:1410-17.
Oulu University Hospital and Oulu University, PoB 23, 90029, OYS, Oulu, Finland.
J-J
JJ
Sinikumpu
Vaasa Central Hospital, Hietalahdenkatu 2-4, 61300, Finland.
S
S
Victorzon
Oulu University Hospital and Oulu University, PoB 23, 90029, OYS, Oulu, Finland.
T
T
Pokka
Oulu University Hospital, Department of Radiology, PoB 50, 90029, OYS, Oulu, Finland.
E-L
EL
Lindholm
Vaasa Central Hospital, Hietalahdenkatu 2-4, 61300, Finland.
T
T
Peljo
Oulu University Hospital and Oulu University, PoB 23, 90029, OYS, Oulu, Finland.
W
W
Serlo
D001864:Bone Wires; 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*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D016059:Range of Motion, Articular; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries
Case-control study; Children; Clinical and radiographic results; Long-term outcome; Supracondylar humerus fracture