A comparative study of outcomes of operative management of Gartland III Supracondylar fractures of the Humerus in children using lateral and posterior approach at University Teaching Hospital, Lusaka

Background
Supracondylar fractures of the humerus are the second most common fracture in children at the University Teaching Hospital (UTH). The average age of occurrence being between 5 to 6 years. Gartland type III fractures pose management challenges hence are treated operatively, using either the lateral or posterior surgical approach. The study has been done to compare which surgical approach gives better outcomes at UTH regarding the cosmetic and functional outcomes using the Flynn’s criteria at 6 and 12 weeks. In addition, the rate of post operative infections between the two approaches was then compared.

Methods
50 patients with Gartland III supracondylar fractures treated operatively using either lateral or posterior surgical approach were enrolled and followed up for a period of 12 weeks. Data collected included post of measurement of the cosmetic and functional outcome using Flynn’s criteria at 6 and 12 weeks and post operative infection (surgical wound and pin site) at 3 week. Additional demographic characteristics (sex, age), cause of injury, affected limb and associated swelling, intra-operative data such as surgical approach used, level of surgeon and method of Kirschner-wire fixation were also collected. Data was analysed using frequency tables, associations using chi square and logistic regression to determine associated factors using SPSS version 20.

Results
Of the recruited patients, 33 (66%) were male (p-value = 0.02). The median age was 6.43yrs. 40% were treated using the lateral approach while 60% with the posterior approach (p-value = 0.16). Postoperatively, 3 weeks follow up showed complication rates as follows: surgical wound infection (5% lateral and 20% posterior), pin site infection (10% lateral and 20% posterior). At 6 weeks, patients that underwent lateral surgical procedure had 71% reduced odds for unsatisfactory cosmetic factor result (OR = 0.29, CI = 0.047 – 1.74). At 12 weeks, there was significant association between cosmetic and functional factors versus surgical approach (P-value < 0.01). Patients that underwent lateral surgical procedure had 82% reduced odds for unsatisfactory functional factor result (OR = 0.18, CI = 0.05 – 0.63).
Conclusion
This study established significant progressive improvement in both cosmetic and functional factor according to Flynn’s criteria from 6 weeks to 12 weeks follow-up using the lateral approach as compared to the posterior approach was noted. Furthermore, the complication rates were found to be more in the lateral approach than the posterior though this finding was not statistically significant (p-value = 0.219 & 0.450). Therefore, the lateral approach yielded better outcomes as compared to the posterior approach in the operative management of Gartland III fractures at UTH.