Ritabh Kumar and Rajesh Malhotra
Department of Orthpaedics, All India Institute of Medical Sciences, New Delhi, India

Twenty-seven widely displaced supracondylar fractures of the humerus in children were treated by open reduction and cross K-wire fixation by the medial approach over a 30-month period. The mean follow-up was 14 months, average age 8 years and the mean delay in presentation 49 hours. Medial approach provided an excellent view of the medial bone pathology via an internervous plane and enabled an anatomical reduction in all cases. Cross K-wire fixation obviated the need to immobilize the elbow at 90 degrees or more flexion. No postoperative neurovascular complication was noted. Most patients regained full range of motion within 6 weeks of pin removal and no change in the carrying angle was noted. Delayed presentation, repeated manipulations and massage were responsible for loss of motion. Superficial pin tract infection was noted in 5 patients and resolved with dressings and antibiotics. No deep infection occurred. Medial approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function.

Key words: ireducible supracondylar humerus fracture; medial approach; medial column comminution