Gekreuzte Kirschner-Draht-Osteosynthese der suprakondylären Humerusfraktur bei Kindern

Objective: Prevention of long-term angular and extension deformity of the elbow and restoration of full range of motion. Indications: Malalignment of > 20° in the sagittal plane in children > 6 years. Rotatory displacement as well as displacement in the frontal plane. Contraindications: Severe cardiorespiratory diseases. Surgical Technique: In most cases, a closed reduction is possible. Fixation of the fracture with two percutaneous Kirschner wires from lateral and medial; the pins cross beyond the fracture line and penetrate the metaphyseal cortex. Postoperative Management: Elbow cast in 90° flexion; the cast has to be split. Removal of cast and pins after 3-4 weeks. Occasionally physiotherapy required. Results: Between October 2005 and September 2006, 77 supracondylar fractures were treated. According to the classification of von Laer 31 were type I (no displacement), 14 type II, nine type III, and 23 type IV (wide displacement). 34 of them required operative treatment due to nine type III and 23 type IV displacements, as well as two cases with (unstable) type II. In all patients treated surgically, the elbow angle was successfully restored. At follow-up after 8-14 months, 32 had regained full range of motion. In two children, extension/flexion was 0-10-120° and 0-10-140°, respectively. Two deficits of the ulnar nerve due to the operation as well as one deficit of the median nerve and the radial nerve due to the initial trauma recovered completely. According to the Flynn Score 32 patients had an excellent outcome; one result was classified as good and one as satisfactory. On the Mayo Performance Score all patients reached 100 of 100 points.