Early Outcome of Delayed Management of Supracondylar Humeral Fractures in Children in Rwanda.

Background: Supracondylar fractures of humerus are the most common in children especially in the first decade of life. They demand proper management to keep functional and cosmetic of the elbow. The incidence of Lagrange &Rigault stage IV fractures is low among the supracondylar fractures of humerus. Different modalities of treatment have been proposed and used for this type of fractures. Among different techniques, the open reduction and fixation with K-wire pinning method was used for this study. The aim of this study was to evaluate the early outcome of open reduction and internal fixation with K-wires pinning of Lagrange &Rigault stage IV supracondylar fractures in children in Rwanda.
Results: Fifty three cases were recruited and 46 of them have completed the follow up for that analyzed. The male sex and the left limb were more frequent in this study. The early functional outcome was studied using the flexion and extension measuring the range of motion and the anatomical outcome was studied measuring the Bauman’s angles. The combination of both range of motion and Bauman’s angles gave the Flynn criteria which was conclusive: Excellent 34.8%, Good 39.1%, Fair 10 (21.7%) and Poor 4.3%. But following the Flynn criteria these results were grouped into two categories such as satisfactory with 95.7% and unsatisfactory with 4.3%. There was no influence of delay on the outcome in this study (P-value: 0. 270) while the persistence of edema on discharge day was however strongly associated with poor outcome measures (p=0.01).
Conclusion: The results from this study showed that open reduction and internal fixation with Kwires cross pinning is still effective method to treat Lagrange &Rigault stage IV supracondylar humerus fractures in children especially in delayed management and in the setting where there is not intensifier imaging. There are different causes of delay of surgery at each level of health care delivery in Rwanda, but the delayed management did not increase the rate of complications following open reduction and internal fixation in Lagrange &Rigault Stage IV supracondylar humerus fractures in children.