A Novel Technique of Arc Fixator for Supracondylar Humerus Fractures in Older Children: A Case Series

Traditionally displaced supracondylar fractures of the humerus are treated by percutaneous pinning and above-elbow slab/cast support. Crossed pinning is commonly used as it provides better biomechanical stability than lateral pinning. The fracture is often associated with a high risk of complications such as neurovascular injury, pulselessness, and the development of swelling or compartment syndrome in acute scenarios. These clinical conditions require regular examination of neurovascular structures and forearm swelling, which is difficult with a slab or cast. Post-surgery Slab or cast has been found to be associated with elbow stiffness, which significantly increases in older children. Here we are presenting an innovative fixation method for such fracture. This retrospective study examined the clinical, radiological, and functional results of ten patients who had displaced supracondylar humerus fractures treated with our novel Arc fixator. 6 out of 10 patients (mean age: 8.2 years; 6-12 years) had a fracture of the non-dominant limb. Flexion injury was seen in one patient with transient ulnar nerve palsy. 3 patients who had injury-related nerve palsy (median 2/ulnar 1), recovered spontaneously at 3 months. Fracture union was observed in all at 6 weeks. All patients achieved a near-normal range of motion (ROM) without deformity at the final follow-up. They had satisfactory scores at 3 months according to Flynn criteria. The construct was found stable and rigid enough to provide fracture stability and allow intermittent ROM exercises. This new method of fixation has the added advantage of regular examination of forearm and neurovascular structures in the postoperative period and allowing early elbow function of the patient, along with being patient-friendly.