The Outcome of Surgical Treatment of Multidirectionally Unstable (Type IV) Pediatric Supracondylar Humerus Fractures

Background: The outcome of multidirectionally unstable (type IV) supracondylar humerus fractures (SCHF) has been rarely described. We aimed to describe several aspects related to the diagnosis, treatment, and outcome of this complex injury. Methods: We analyzed the clinical and radiographic data on 130 completely displaced SCHF in children, which was collected prospectively over a 6-year period (2007 to 2013), as part of an IRB-approved study. A minimum follow-up of 6 weeks was required. We compared the outcome of type IV SCHF (n= 12, group 1) with that of type III SCHF (n= 118, group 2) by assessing the need for open reduction, length of operative time, recovery of range of motion (as compared with the normal, contralateral side), and rate of complications. Results: An open reduction was required in 17% and 2% of fractures in groups 1 and 2, respectively (P= 0.04). A medial pin was added to supplement the fixation in 42% and 17% of fractures in groups 1 and 2, respectively (P= 0.05). An acceptable reduction was obtained in all fractures. Surgery was longer for fractures in group 1, by a mean of 22 minutes (P= 0.0001). No patient in either group required a reoperation. There was no significant difference between groups with respect to the latest range of motion of the treated side, as compared with the normal contralateral side (98% vs. 97%, respectively, P= 0.4). Satisfactory outcomes were found in 92% and 98% of patients in groups 1 and 2, respectively (P= 0.6). Conclusions: The results of this study suggest that a satisfactory outcome can be expected when treating type IV SCHF in a child. Although these fractures are associated with increased levels of technical difficulty, given the increased need for open reduction, utilization of medial pins, and longer surgical times, adequate reductions and satisfactory mid-term to long-term outcomes can be achieved.