Is long arm splinting sufficient in the nonsurgical follow-up of pediatric Type I and Type IIa supracondylar humerus fractures?

BACKGROUND: This study aims to compare the radiological and functional outcomes of long arm casting versus splinting in the nonsurgical treatment of pediatric supracondylar humerus fractures classified as Modified Gartland type I and IIa.
METHODS: Between January 2021 and January 2024, 112 pediatric type I and IIa supracondylar humerus fractures (SCHFs) treated nonoperatively with long arm splinting or casting were evaluated. Baumann angle and lateral capitellohumeral angle (LCHA) were measured pre-reduction, post-reduction, and at weeks 1 and 4. Outcomes were compared using Flynn’s criteria.
RESULTS: Of the 112 patients, 55 had type I (49%) and 57 had type IIa (51%) fractures (mean age: 7.51 years; 69 males, 43 females). Fractures were equally distributed between the right and left sides (n=56 each). Fifty-eight patients were treated with long arm splinting and 54 with long arm casting. Follow-up durations were similar between groups. In the splint group, the mean Baumann angle was 72.1° pre-reduction and 73.2° at week 4; in the cast group, it was 70.7° and 73.4°, respectively. Mean LCHA increased from 43.9° to 50.8° with splinting and from 42.4° to 50.1° with casting. A statistically significant difference was not observed for loss of reduction between the splinting and casting groups (p=0.475). No statistically significant differences were observed in LCHA (p=0.175), Baumann angle values (p=0.485), or Flynn scores (p=0.768) pre- and post-reduction in type I and type IIa SCHFs.
CONCLUSION: Splinting and casting yielded comparable clinical and radiological outcomes in nonsurgically managed Modified Gartland type I and IIa supracondylar humerus fractures. However, splinting stands out as a strong alternative due to its ease of application and lower complication rates.

Keywords: Supracondylar humerus, fractures, elbow, reduction, pediatric.

Pediatrik Tip I ve Tip IIa suprakondiler humerus kýrýklarýnýn cerrahi dýþý takibinde uzun kol atel uygulamasý yeterli midir?

AMAÇ: Bu çalýþma, pediatrik, deðiþtirilmiþ Gartland tip I ve IIa suprakondiler humerus kýrýklarýnýn cerrahi dýþý tedavisinde uzun kol alçý ve atel uygulamalarýnýn radyolojik ve fonksiyonel sonuçlarýný karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Ocak 2021 ile Ocak 2024 tarihleri arasýnda, uzun kol alçý veya atel ile cerrahi dýþý olarak tedavi edilen 112 pediatrik tip I ve IIa suprakondiler humerus kýrýðý (SCHF) retrospektif olarak deðerlendirildi. Bauman açýsý ve lateral kapitellohumeral açý, redüksiyon öncesi, sonrasý, 1. hafta ve 4. haftalarda ölçüldü. Klinik ve radyolojik sonuçlar Flynn kriterleri kullanýlarak karþýlaþtýrýldý.
BULGULAR: Çalýþmaya dahil edilen 112 hastanýn 55’inde tip I (%49), 57’sinde tip IIa (%51) kýrýk mevcuttu (ortalama yaþ: 7.51 yýl; 69 erkek, 43 kýz). Kýrýklar sað ve sol dirseklerde eþit daðýlým gösterdi (n=56). Elli sekiz hasta uzun kol atel ile, 54 hasta ise uzun kol alçý ile tedavi edildi. Takip süreleri her iki grupta da benzerdi. Atel grubunda ortalama Bauman açýsý redüksiyon öncesi 72.1°, 4. haftada 73.2°; alçý grubunda ise sýrasýyla 70.7° ve 73.4° olarak ölçüldü. Ortalama lateral kapitellohumeral açý atel ile 43.9°’den 50.8°’ye, alçý ile 42.4°’ten 50.1°’e yükseldi. Atel ve alçý uygulanan gruplar arasýnda redüksiyon kaybý açýsýndan istatistiksel olarak anlamlý bir fark gözlenmemiþtir (p=0.475). Tip I ve tip IIa SCHF olgularýnda, redüksiyon öncesi ve sonrasý LCHA (p=0.175), BA deðerleri (p=0.485) ile Flynn skorlarý (p=0.768) arasýnda istatistiksel olarak anlamlý bir fark bulunmamýþtýr.
SONUÇ: Cerrahi dýþý tedavi edilen deðiþtirilmiþ Gartland tip I ve IIa suprakondiler humerus kýrýklarýnda atel ve alçý uygulamalarý benzer klinik ve radyolojik sonuçlar vermektedir. Ancak atel, uygulanabilirliðinin kolaylýðý ve daha düþük komplikasyon oraný nedeniyle güçlü bir alternatif olarak öne çýkmaktadýr.

Anahtar Kelimeler: Suprakondiler humerus, kýrýk, dirsek, redüksiyon, pediatrik.