Open Reduction and Internal Fixation of Gartland Type III Supracondylar Humerus Fractures Using the Posterior Paratricipital Approach: A Case Series.

Introduction: Gartland type III supracondylar fractures of the humerus in children are completely displaced injuries often posing challenges to closed reduction, particularly in cases with severe swelling, instability, or neurovascular compromise. Open reduction and internal fixation remains a reliable option in such cases. Mini open methods from the lateral aspect are frequently used to avoid injury to the blood supply and major scars in children. However, the posterior paratricipital (triceps-sparing) approach allows direct fracture visualization to achieve better reduction and avoid growing deformities. Materials and Methods: This prospective case series included patients aged 5-10 years with Gartland type III supracondylar fractures treated at Kalinga Institute of Medical Sciences, Bhubaneswar, between November 2023 and January 2025 after approval from the ethical committee. All patients underwent open reduction through a posterior paratricipital approach and Kirschner wire fixation. Demographic data, injury characteristics, operative details, and complications were recorded. Patients were followed for a minimum of 1 year. Outcomes were assessed using Flynn's criteria, range of motion, carrying angle, and radiographic alignment. Results: A total of 38 patients (mean age ~7.4 years) were included. According to Flynn's criteria, excellent to good outcomes were observed in 92.1% (35) of the patients. The mean loss of elbow motion was minimal, and no patient had clinically significant cubitus varus deformity. There were no cases of deep infection, triceps weakness, or iatrogenic neurovascular injury. Conclusion: Open reduction and pinning via the posterior paratricipital approach is a safe, effective, and reproducible technique for managing Gartland type III supracondylar humeral fractures, providing stable fixation and satisfactory functional outcomes.