Triceps-sparing Posterior Approach for Supracondylar Fractures in Children

Document Type : RESEARCH PAPER


1 5th Azar Hospital, Bone, Joint, Connective Tissue Research Center, Gorgan, Iran

2 Shoulder and Elbow Department, IRCCS Humanitas Institute, Rozzano, Milan, Italy


Background: The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% of
elbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation of
type III supracondylar humeral fractures using a Triceps sparing posterior approach.
Methods: In total, 98 patients were evaluated from June 2007 to 2014.
Results: According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and the
right to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which was
right. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internal
fixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3
months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° and
the obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determined
at 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopic
ossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nerve
palsy, two of which happened before surgery, and the other two following the surgery. All of these complications were
resolved within 3 to 10 weeks spontaneously.
Conclusion: This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptable
skin scar esthetically along with satisfactory postoperative function.
Level of evidence: IV


Main Subjects

1. Minkowitz B, Busch MT. Supracondylar humerus
fractures. Current trends and controversies. Orthop
Clin North Am. 1994; 25(4):581-94.
2. Alton TB, Werner SE, Gee AO. Classifications in
brief: the Gartland classification of supracondylar
humerus fractures. Clin Orthop Relat Res. 2015;
3. Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE.
Delay increases the need for open reduction of type-
III supracondylar fractures of the humerus. J Bone
Joint Surg Br. 2006; 88(4):528-30.
4. Turhan E, Aksoy C, Ege A, Bayar A, Keser S, Alpaslan
M. Sagittal plane analysis of the open and closed
methods in children with displaced supracondylar 
fractures of the humerus (a radiological study). Arch
Orthop Trauma Surg. 2008; 128(7):739-44.
5. Lieberman JR, Staheli LT, Dales MC. Tourniquet
pressures on pediatric patients: a clinical study.
Orthopedics. 1997; 20(12):1143-7.
6. Zionts LE, McKellop HA, Hathaway R. Torsional
strength of pin configurations used to fix
supracondylar fractures of the humerus in children.
J Bone Joint Surg Am. 1994; 76(2):253-6.
7. O’driscoll SW, Spinner RJ, McKee MD, Kibler WB,
Hastings H, Morrey BF, et al. Tardy posterolateral
rotatory instability of the elbow due to cubitusvarus.
J Bone Joint Surg Am. 2001; 83(9):1358-69.
8. Azar FM, Canale ST, Beaty JH. Campbell’s operative
orthopaedics e-book. New York: Elsevier Health
Sciences; 2016. P. 1435-8.
9. Pretell Mazzini J, Martin JR, Andres Esteban EM.
Surgical approaches for open reduction and pinning
in severely displaced supracondylar humerus
fractures in children: a systematic review. J Child
Orthop. 2010; 4(2):143-52.
10. Rockwood CA. Rockwood and Wilkins’ fractures
in children. Philadelphia: Lippincott Williams &
Wilkins; 2015. P. 581-629.
11. Aktekin CN, Toprak A, Ozturk AM, Altay M, Ozkurt
B, Tabak AY. Open reduction via posterior triceps
sparing approach in comparison with closed
treatment of posteromedial displaced Gartland
type III supracondylar humerus fractures. J Pediatr
Orthop B. 2008; 17(4):171-8.
12. Rizk AS. Triceps-sparing approach for open
reduction and internal fixation of neglected displaced
supracondylar and distal humeral fractures in
children. J Orthop Traumatol. 2015; 16(2):105-16.
13. Sibly T, Briggs P, Gibson M. Supracondylar fractures
of the humerus in childhood: range of movement
following the posterior approach to open reduction.
Injury. 1991; 22(6):456-8.
Volume 7, Issue 5
September 2019
Pages 416-421
  • Receive Date: 09 December 2016
  • Revise Date: 20 November 2018
  • Accept Date: 08 December 2018
  • First Publish Date: 01 September 2019