Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children

Objectives: We compared the functional and cosmetic results of lateral and medial approaches in the surgical treatment of type III supracondylar humeral fractures in children. Methods: The study included two groups in which type III supracondylar humeral fractures were treated using either later¬al (12 boys, 8 girls; mean age 7.2 years; range 4 to 12 years) or medial (16 boys, 4 girls; mean age 7.4 years; range 3 to 11 years) approaches and internal fixation. Functional and cosmetic results were assessed according to the criteria proposed by Flynn et al. The mean follow-up periods were 19.8 months (range 8 to 30 months) and 19.5 months (range 12 to 27 months) in the lat¬eral and medial approach groups, respectively. Patient satisfac¬tion was also inquired regarding the site of the incision scar. Results: In the lateral approach group, functional results were excellent in 18 patients (90%), good in one patient (5%), and fair in one patient, while cosmetic results were excellent in 19 patients (95%) and good in one patient. In the medial approach group, 19 patients (95%) had excellent and one patient (5%) had good functional results, while all the patients had an excel¬lent cosmetic result (p>0.05). Complications were seen only in the lateral approach group, including transient ulnar nerve palsy in one patient, and cubitus varus deformity due to limit¬ed range of motion in another. The satisfaction rates concern¬ing the site of the incision scar were 25% and 70% in the lat¬eral and medial approach groups, respectively. Conclusion: Although no significant differences were found between the lateral and medial approaches in terms of functional and cosmetic results, the medial approach may be more convenient due to a lower risk for ulnar nerve injury and to a greater acceptability of the medial incision scar on the part of the patients.