title: Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should Be Used After Failed Closed Reduction?
abstract: OBJECTIVE
  For displaced supracondylar humeral fractures in children, in the event of closed reduction failure, anatomic reduction is achieved via open reduction techniques; however, there are no confirmative reports among the published open reduction approaches that deliver the best functional and cosmetic results. Here, we compared long-term functional and cosmetic results of different surgical approaches.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Ankara Education and Research Hospital/Turkey. Secondary care hospital and trauma center.
  
  
  METHODS
  We evaluated 70 surgically treated Gartland type 3 supracondylar humeral fractures. Patients, with detailed history record, were divided into 5 groups with respect to surgery methods.
  
  
  METHODS
  All patients were treated surgically using closed reduction and percutaneous pinning or 4 different open reduction approaches and percutaneous pinning.
  
  
  METHODS
  Flynn cosmetic and functional score results were compared between surgical groups.
  
  
  RESULTS
  Posterior open reduction and triceps transection groups showed worst results, whereas medial and lateral open reduction groups showed good to excellent results similar to closed reduction group.
  
  
  CONCLUSIONS
  Medial and lateral approaches demonstrated better functional results than posterior and triceps transection approaches. Posterior approaches lead to restrictions in extension and poor functional results. In the posterior approach, transecting triceps from olecranon does not benefit from fracture reduction but results in loss of triceps strength and should be avoided. In failed closed reduction, medial and lateral open reduction approaches lead to similar cosmetic outcomes and functional results that are only slightly worse compared with those in closed reduction.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics and Traumatology Clinic, Turan and Turan Muscle, Bone and Joint Surgery Center, Altıparmak caddesi, Bursa, Turkey;†Department of Orthopaedics and Traumatology Clinic, Ankara Training and Research Hospital,‡Department of Orthopaedics and Traumatology Clinic, Memorial Hospital, and§Department of Orthopaedics and Traumatology Clinic, Medical Park Hospital, Ankara, Turkey.
authors.forename: Yusuf Onur
authors.initials: YO
authors.lastname: Kzlay
authors.forename: Cem Nuri
authors.initials: CN
authors.lastname: Aktekin
authors.forename: Mehmet Hakan
authors.initials: MH
authors.lastname: Özsoy
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Akşahin
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Sakaoğullar
authors.forename: Murad
authors.initials: M
authors.lastname: Pepe
authors.forename: Onur
authors.initials: O
authors.lastname: Kocadal
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D000070628:Closed Fracture Reduction / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007223:Infant; D008297:Male; D000070799:Open Fracture Reduction / Q000295:instrumentation* / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome