Comparison of treatment outcomes between two surgical approaches for treating pediatric displaced supracondylar humeral fractures

Objective To compare the results between two surgical approaches for treating complex supracondylar humeral fractures in children.Methods Open reduction and internal fixation with Kirschner-wires were carried out through a posterior incision around the elbow to treat 34 cases of pediatric displaced supracondylar humeral fractures from July 2010 to December 2011.These cases were divided into two groups based on the way with which the triceps brachii was managed.In group A (triceps-splitting approach) the triceps was split in the midline to allow access,while in group B (paratricipital approach) access was gained via a lateral triceps approach.The patients were follow-up postoperatively for 16 to 32 months,with an average of 21.7 months.Objective and subjective functional results (elbow range of motion including flexion/extension and pronation/supination,the strength of triceps muscle,carrying angle,Mayo Elbow Performance Score) and radiographic data (Baumarm angle,humerocapitellar angle) were assessed.The last follow-up evaluations were compared between the two groups.Results Elbow range of motion,carying angle,Baumann angle and humerocapitellar angle were in the normal range for both groups.There was no difference between the two groups.No significant difference was found between the two groups in the percent strength of triceps muscle normalized against the healthy side.Both groups achieved 100 Mayo Elbow Score showing no differences between the groups.Conclusion The triceps-splitting approach and paratricipital approach have comparable clinical results when used to treat pediatric displaced supracondylar humeral fractures. Key words: Children;  Fracture fixation, internal;  Supracondylar humeral fracture;  Functional assessment;  Surgical approach