Radiographic outcomes after treatment of pediatric supracondylar humerus fractures using a treatment-based classification system.

OBJECTIVES

To develop a radiographic method to categorize supracondylar fractures into four types that have logical treatment correlations. The new classification is described, illustrated, and then tested to see if it is reproducible, safe, and effective.

DESIGN

Clinical follow-up study.

SETTING

Level I trauma center.

PATIENTS

One hundred forty-one extension-type supracondylar fractures.

INTERVENTION

According to our system, a long arm cast without reduction was indicated for no or little displacement (Type I), closed reduction and long arm casting was indicated for minimal displacement (Type II), closed reduction and lateral pinning was indicated for moderate displacement (Type III), and closed or open reduction and medial-lateral crossed pinning was indicated for complete displacement (Type IV).

MAIN OUTCOME MEASURE

Baumann's angle (anteroposterior) and the shaft-condylar angle (lateral).

RESULTS

: No significant differences were observed among the four types with respect to changes in Baumann's angle or the shaft-condylar angle. No patient experienced a major loss of reduction and no iatrogenic ulnar nerve injury was encountered.

CONCLUSIONS

The described treatment-based classification of extension-type supracondylar humerus fractures demonstrates promising results.