Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children

Abstract

The purpose of the study was to compare the efficacy of conservative and surgical treatments for Gartland type II supracondylar humerus fractures in children. We assessed 142 patients with type II supracondylar humerus fractures treated in our hospital from February 2018 to February 2019. The patients were divided into two groups: initial conservative treatment (Group A) and initial surgical treatment (Group B). Clinical outcomes were measured by the Flynn scoring system. Variables were analyzed using a statistical approach between those groups. All patients were followed up for 6–12 months. The rate of loss reduction was 19.8% in patients treated conservatively, and the incidence of pin infections was 7.1% in patients treated surgically. Although there were no statistical differences between the three groups in fracture healing time and Flynn score, the conservative treatment was superior to surgical treatment in functional recovery times. At the last follow-up, all fractures had healed without iatrogenic vascular or nerve injury, Volkmann’s contracture, or cubit varus deformity. Conservative treatment is safe and effective for the treatment of Gartland type II supracondylar fracture and represents a faster recovery time of elbow range of motion as compared with surgical treatment. Type IIB had a 41.3% risk of secondary displacement versus 5.3% for IIA, but we still prefer closed reduction. However, closed reduction of Garland type II must be followed accurately in the first 2 weeks to identify patients with loss of reduction. The patients who loss reduction can be treated with percutaneous pinning, and the clinical effect was consistent with immediate surgical treatment. Level of evidence: level III.