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DETERMINANTS OF POST-PROCEDURAL SURGICAL OUTCOME AMONG PEDIATRIC PATIENTS UNDERGOING OPEN REDUCTION INTERNAL FIXATION FOR SUPRACONDYLER FRACTURE OF THE HUMERUS (GARTLAND TYPE – III CLASSIFICATION)

Hussain Bux Palh, Najeeb ur Rehman, Mansoor Ali Abbasi, Irshad Ahmed, Ishtiaque Ali Memon, Aatir H. Rajput

Background: Supracondylar fracture of Humerus in children is the second most common fracture around the elbow joint and is also called first decade injury typically affecting non-dominant arm. Its incidence is reported to be as high as 308/100,000 per year. Despite effective surgical interventions, the best outcome isn’t always achieved owing to a variety of factors. Objective: To identify the determinants of post-procedural surgical outcome among pediatric patients undergoing open reduction internal fixation for supra-condyler fracture of the humerus (Gartland type – III classification). Methodology: This prospective cohort was conducted upon a sample of 30 pediatric patients (chosen via simple random sampling), admitted through both out-patient and casualty departments of orthopedic unit-1 Liaquat University Hospital Hyderabad/Jamshoro after taking written informed consent from parents/guardians. Our study entailed the operative treatment i.e. open reduction internal fixation with two cross pin fixation or two lateral pinning in supracondylar fractures of humerus (Gartland type III). Functional outcomes were assessed at each follow-up visit and recorded on pre-structured questionnaire. Data was analyzed using SPSS v.21 & Microsoft Excel 2016. Results: Among, the 30 pediatric patients, 19 were males while the remaining 11 were females. Good outcome was seen in 21 patients while 9 patients had an excellent outcome. Among the hypothesized determinants of post-procedural outcome, type of surgery (fixation with two cross pin fixation or two lateral pinning), delay in presentation to the hospital, age of the patients were significant, while others such as child gender, weight and serum calcium levels were not significant determinants. Conclusion: After careful consideration, it can be concluded delay in presentation to the hospital should be avoided following supra-condyler fracture of the humerus, as it may adversely affect the post-procedural outcome. Lateral pinning too proved to be a superior surgical approach and thus should be adopted for said fractures among pediatric patients. Keywords: Supra-Condyler Fracture, Lateral Pinning, Cross-Pinning, Open Reduction – Internal Fixation & Pediatric Orthopedic Surgery.

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