Assessment of elbow functional outcome after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children
Background: The aim of the current study was to establish the functional outcome of Gartland grade III extension-type supracondylar fractures at 24 weeks after closed reduction and percutaneous pinning (CRPP) without physiotherapy. The objectives of this study were 1) to measure the elbow range of motion (ROM) at three, six, 12 and 24 weeks after CRPP for grade III supracondylar fractures; 2) to assess the functional outcome of the injured limb using the Paediatric Outcome Data Collection Instrument (PODCI) score; 3) to compare elbow functional outcome of children less than 7 years old versus children more than 7 years old and 4) to assess other risk factors or complications associated with poor outcomes after CRPP (including age and associated soft tissue injury).
Patients and methods: A prospective cohort study was performed. The study included 38 children under the age of 14 years with grade III extension-type supracondylar fractures who had manipulation under anaesthesia (MUA) and crossed K-wire fixation. ROM of the affected elbow (flexion, extension, pronation and supination) was measured at three, six, 12 and 24 weeks after CRPP by the same author (AR) at each visit. The unaffected elbow was used as a control. The PODCI was also recorded. No physiotherapy was prescribed.
Results: Thirty-eight children were included in the study. All components of elbow ROM improved at 24 weeks (p<0.001). At 12 but not 24 weeks, the mean elbow extension was reduced in comparison with the controls (p=0.009). Patients less than 7 years of age recovered extension more rapidly (p=0.001). Seventy-six per cent of the children achieved satisfactory PODCI results at the 24-week final follow-up. Nerve palsy (18.4%) and severe soft tissue injuries (7.9%) were the main contributory factors to a poor outcome on the PODCI assessment.
Conclusion: The majority of children with displaced supracondylar fractures recover full ROM after CRPP by 24 weeks without physiotherapy. Older children, or those with associated neurovascular and soft tissue injuries had poor functional outcomes. Further studies are needed to assess if these patients will benefit from physiotherapy.
Level of evidence: Level 4