Evaluation of anterior approach in failed closed reduction and delayed presentation of supracondylar humerus fractures in children

Background: The treatment of displaced paediatric supracondylar fracture is a challenging problem and requires strict vigilance and a proper management protocol. Prospective investigation of the treatment options for fractures that cannot be reduced by closed reduction is recommended in literature. Operative treatment is indicated for the fractures that cannot be reduced satisfactorily by closed methods. It is also considered the best option for late presenting fractures. The aim of this study was to assess and compare the clinical outcome using open reduction through anterior approach in delayed presentation and failed closed reduction of supracondylar fracture humerus in children. Materials and methods: 15 patients of failed closed reduction and 11 patients of delayed presentation of supracondylar humerus fractures were operated with anterior approach. The demographic data, time from injury to presentation and from admission to surgery, reasons for delayed presentation, type of fracture, operative findings and time, K-wire configuration, length of hospitalization, post operative complications were noted. The patients were followed up for a period of 12 months and final range of motion, Baumann's angle, and cosmetic, functional and overall outcome by Flynn's criteria were evaluated and analyzed. Results: The overall outcome was very satisfactory according to Flynn's criteria. 80.77% patients had excellent, 15.38% patients had good, and 3.85% patient had fair results with no poor results. Our results show distinct advantage of anterior approach which are on a par with or better than the previous studies using anterior approach, adding to their evidence. Conclusion: Open reduction using anterior approach is a very safe, logical and effective technique of treating failed closed reduction or late presentation of supracondylar fractures humerus in children with excellent cosmetic and functional results, and offers distinctive advantage over other approaches.