Medial approach for fixation of displaced supracondylar fractures of the humerus in children.

This study aimed at evaluating our protocol for displaced Gartland Type 3 supracondylar fractures of the humerus in children. Forty-eight children had 49 fractures during the study period, from 1997 to 2002; they were included in the study. Their mean age was 7.02 years. They all were treated with crossed K-wires. The medial wire was always put under direct vision through a medial approach. All fractures were manipulated maximum twice. Ten patients (23.25%) required open reduction which was done through the same medial approach which we use for medial pin placement. No patient had iatrogenic ulnar nerve neuropathy. At final review radiographs were taken of the normal and operated sides and films were compared with immediate post-op films. The postoperative mean value of Bauman's angle in the affected elbow was 76.7 degrees with a range of +/- 1.0 degrees and 74.8 degrees with a range of +/- 0.6 degrees on the unaffected elbow. Carrying angle and movements of operated and normal sides were measured at review. According to Flynn's criteria, all patients showed satisfactory results. We conclude that cross K-wiring gives excellent results; the medial approach provides an excellent view of the supracondylar area, leaves a cosmetically acceptable scar and enables to avoid iatrogenic injury to the ulnar nerve.