Evaluation of Elbow Range of Motion Following Delayed Surgical Fixation of Pediatric Supracondylar Humerus Fractures: A Prospective Study

Abstract

Introduction: To achieve excellent functional outcome in Pediatric Supracondylar fractures, early surgical fixation is recommended. Unfortunately, there are still some cases which have delayed presentation to the medical health care, leading to delay in appropriate management required for a good functional outcome. We studied the functional outcome, in terms of range of motion following fixation of type III supracondylar fracture of humerus in children presenting 10 days after initial injury. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 44 pediatric patients presenting to the Emergency and outpatient department with initial trauma to affected elbow more than 10 days old with Supracondylar Fracture of Humerus extension type III were admitted and Open Surgical Fixation with K-wires was performed and Half Cast above elbow was applied for 3 weeks. Goniometer was used to measure range of motion of the effected elbow following the removal of half cast on the day of removal of cast, at 1 week, 2 weeks, and then at 2 weekly intervals until 90 % of Range of motion of the contralateral normal elbow was achieved. Results: The mean delay in presentation was 13.20 ± 2.66 days. None of the patients had close manipulation attempted. Mean Hospital stay was 40.20 ± 1.46 hours. It took a mean of 35.25±2.79 and 49.43± 1.21 days to achieve 90% range of motion in extension and flexion (p-value ≤ 0.001). On average extension was achieved earlier than flexion range of motion. Conclusion: Our study showed good functional outcome in terms of elbow flexion and extension in patients managed after delayed presentation of supracondylar humerus fracture but taking longer time to achieve 90% ROM of the normal elbow. Despite delayed presentation being common in our population, it is not associated with increased peri and post-op complications. Because the ROM improves over time, prolonged follow up is all that is required in such patients. Key words: Delayed fixation, Pediatric, Supracondylar Fracture