title: Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation.
abstract: BACKGROUND
  Percutaneous pinning has been accepted as the "gold standard" for displaced supracondylar humeral fracture (SHF) in children. However, to secure an anatomic reduction and to reduce the rotated fragment, open reduction is often necessary when there is inadequate stabilization or a satisfactory reduction has failed to be achieved. The study aimed to compare the efficacy of the open reduction and bioabsorbable poly-d,l-lactic acid (PDLLA) pin fixation method with the closed reduction and lateral external fixation method in irreducible delayed Gartland type III SHF in children.
  
  
  METHODS
  In this study, 124 consecutive patients with irreducible delayed Gartland type III SHF were included between 2005 and 2013. Two different surgical methods were performed in patients separately. Group I had 64 patients undergoing bioabsorbable PDLLA pin fixation after open reduction, whereas group II had 60 patients treated by lateral external fixation after closed reduction. The outcome of treatment was evaluated by the Mayo Elbow Performance Score and the criteria of Flynn.
  
  
  RESULTS
  Operation duration was longer in group I than in group II. Scoring of function showed that all patients had satisfactory results in both groups. The cosmetic result was satisfactory in all patients except 1 in group I.
  
  
  CONCLUSIONS
  Both bioabsorbable PDLLA pin fixation and lateral external fixation are reliable, safe treatment alternatives for irreducible delayed SHF. Neither open nor closed reduction is linked to an increased rate of perioperative complications or unsatisfactory functional results.
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: DeHao
authors.initials: D
authors.lastname: Fu
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Chong
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: ShangYu
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: RenHao
authors.initials: R
authors.lastname: Ze
authors.affiliation: Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: 56415607@qq.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Tang
mesh_terms: D020341:Absorbable Implants; D001858:Bone Nails; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004551:Elbow Joint; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D000070799:Open Fracture Reduction / Q000379:methods; D011091:Polyesters; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; C033616:poly(lactide)
keywords: Delayed; bioabsorbable pin; children; external fixation; irreducible; supracondylar humeral fractures