Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children.

Eighty-four patients who underwent open reduction and Kirschner wire (K-wire) fixation for supracondylar humerus fractures through anterior or lateral approach with or without additional medial incisions were compared with regard to complications and end results. A total of 46 patients were operated through the anterior and 38 through the lateral approach. In lateral approach cases, medial incision was added only in those patients in whom the medial condyle and therefore the ulnar nerve were not easily distinguished due to excessive oedema. All the fractures were Gartland type III extension fractures. The patient series was consecutive, and lateral approach had a longer follow-up of 89 months (70-134 months); the incision protocol was changed approximately mid-series to the anterior approach, and therefore a shorter follow-up time of only 50 months (24-84 months) was possible. All patients were treated according to the same postoperative protocol. A follow-up examination was performed and all the patients were evaluated according to Flynn's criteria; loss of flexion or extension clinically, any deviation of the carrying angle radiologically, and the appearance of the incision scar were evaluated. According to the above parameters, results were excellent in 19, good in 18, and fair in one in the lateral incision group, whereas in the anterior incision group, excellent results were obtained in 31 patients and good results in 15 of them. Cosmetically, two patients in the lateral incision group had hypertrophic scar tissue, whereas the anterior incisions were barely noticeable as they were included into the flexion crease. In conclusion, we can say that anterior incision when open reduction is needed in pediatric supracondylar fractures offer the advantage of a smaller scar and easy access to structures that might be injured between the fractured fragments.