Correlation Between Baumans and Carrying Angle in Children with Supracondylar Fracture of Humerus

DOI: 10.5455/medarh.2013.67.195-197
Med Arh. 2013 Jun; 67(3): 195-197
Received: January 21th 2013 | Accepted: March 15th 2013

CONFLICT OF INTEREST: NONE DECLARED

original paper

Correlation Between Baumans and Carrying

Angle in Children with Supracondylar Fracture of
Humerus
Nedim Smajic1, Jasmina Smajic2, Sahmir Sadic1, Mahir Jasarevic1, Jasmina Ahmetovic-Djug2, Renata Hodzic3
University Clinical Centre, Orthopaedic and Traumatology Clinic, Tuzla, Bosnia and Herzegovina1
University Clinical Centre, Anesthesiology and Reanimatology Clinic, Tuzla, Bosnia and Herzegovina2
University Clinical Centre, Neurology Clinic, Tuzla, Bosnia and Herzegovina3

upracondylar fractures are the result of a fall on outstretched hand in more than 70% of
cases, and more common in the non-dominant arm. Baumans angle is used to determine
the degree of displacement and angulation, and the quality of fracture reduction. Carrying
angle is the clinical parameter of varus-valgus angulation with elbow fully extended and forearm
completely supinated. Patients and methods: The study was a retrospective-prospective and
there were analyzed children under 14 years of age with supracondylar humerus fracture. They
were analyzed by X-ray anteroposterior view of injured elbow, made before

and after the surgery,

with measuring Baumans angle. Clinical examination was performed after completing physical
therapy, when was measured carrying angle of the injured and healthy elbow using a goniometer.
Results and discussion: The results showed that there is a negative correlation Bauman and
carrying angle of injured elbow (r=-0.543, p <0.0001). Analyzing Baumans angle deviation from
value of 75 and the loss of carrying angle there is noticed significant positive correlation between
the Bauman angle deviation and loss of carrying angle. Baumans angle correlates well with the
carrying angle and can be used as an indicator of the potential cosmetic complications. Conclusion: Carrying angle of uninjured elbow measured when reviewing a child who has suffered
supracondylar fracture, can serve as a useful parameter in the assessment of real Baumans angle,
thereby the adequacy of fracture reduction on the injured arm. Keywords: supracondylar fracture,

humerus, Baumans angle, carrying angle

Correspondent author: Mr. sci. Nedim Smajic, MD. Phone: 00387 61 731 212. E-mail:ena_s@bih.net.ba,

1. INTRODUCTION
Supracondylar fractures are the
result of a fall on outstretched hand
in more than 70% of cases, and more
common on the non dominant arm.
Children tend to protect themselves
with extending the arm during the
fall, thereby explaining the high incidence of fracture of the upper extremity. Supracondylar fractures are the
most common cause of hospitalization
of children with elbow injury (1, 2).
They occur in two basic types: extension, more common type (98%), and less

common flexion type (2%). Extension

type of supracondylar fracture usually
occurs in the fall on the outstretched
hand with elbow in hyper extension,
and flexion type as a result of the direct
effect of force on the back of the elbow.
Diagnosis of supracondylar fracture is
based on the clinical signs and radiological examinations (3). To determine the
degree of displacement and angulation,
and the quality of fracture reduction is
used Baumans angle (4). Baumans angle is measured after fracture reduction on the anteroposterior X-ray view,

and it is represented by a line that goes

along the epiphiseal capitulum and the
longitudinal axis of the humerus. Normal value is 75 , while the increase in
value by 5 or more indicates varus deformity, a decrease of 5 and more valgus deformity (5, 6). Carrying angle is
the clinical indication of varus-valgus
angulation of the arm with elbow fully
extended and forearm completely supinated. This angle is defined by the section of the line that runs along the middle axis of the arm and the line that runs
along the middle axis of forearm. There
is no significant difference in the carrying angle value in men and women, but
there is significant difference based on
age. At the age of 0-4 years the value is
about 15 and 17.8 in adults. Increasing
this angle indicates a valgus deformity,
and reducing the varus deformity (7).

2. AIM
The aim of this study was to determine the correlation between Baumans
angle measured on the anteroposterior
X-ray view injured arm after reduction,
and carrying angle injured arm after
finished treatment.

3. SUBJECTS AND
METHODS
The study was a retrospective-prospective and analyzed for children under 14 years of age with supracondylar

Med Arh. 2013 Jun; 67(3): 195-197 original paper

195

Correlation Between Baumans and Carrying Angle in Children with Supracondylar Fracture of Humerus

humerus fractures, surgically treated at

Orthopedic-Traumatology Clinic of the
University Clinical Center Tuzla in the
period from January 2005 to September 2010. Including criterion was completely displaced supracondylar fracture of humerus (Gartland type III
extension type), while excluding criterion was an open fracture, as well as the
existence of another a fracture on the
same hand. The proper medical documentation was used: case histories, Xray images before and after treatment,
and ambulatory protocols. Postoperative testing was performed at least three
months after surgery. Random selection
method selected 60 subjects who were
invited and analyzed as follows:
The first group (group 1) were patients who were hospitalized for up to
24 hours of the injury and who were
immediately treated surgically without
attempting closed fracture reduction
and cast immobilization. The second
group (group 2) were patients who underwent surgery after 24 hours of injuries; surgical treatment after this period
was made because the respondents appeared later, or a failed closed fracture
reduction with cast immobilization
Anteroposterior X-ray views of injured elbow were analyzed, made before
and after surgery. Preoperative images
were used to confirm the diagnosis supracondylar fractures and determine
the degree of dislocation. Postoperative recordings were used to assess the
quality of the repositioning of the fracture. Baumans angle was measured.
Baumans angle was measured on the
anteroposterior image, and presented
to the lines that go to the longitudinal axis of the humerus capitulum and
along the epiphysis. The values of
this
angle 75 5 were considered as anatomical reconstruction.
After completing the physical
therapy clinical examination was performed, which was measured carrying angle of the injured and healthy elbow. Carrying angle was measured using a goniometer, in the full extension
of forearm. It is defined by the section
of the line that runs along the middle
axis of the arm and the line that runs
along the middle axis of forearm. Based
on data obtained the degree of loss of
carrying angle injured compared to
196

Mean
Variance
Standard deviation

Group 1
75.73333
33.85747
5.818717

FIGURES AND TABLES

cation (dislocations 1), and decrease in

the posterolateral dislocation of the disTable 1. Bauman's angle values in studied groups
tal
fragment (dislocations 2) (Figure 2).
Group 1
2
The
mean carrying
angleGroup
of the
injured
Mean
75.73333
76.23333
Variance
38.73678 therapy
elbow after 33.85747
completing physical
Standard deviation
5.818717
6.223888
in group 1 was 11.90 7.80 , and in second group 13.37 6.89 (p = 0.21). The

Group 2
76.23333
38.73678
6.223888

Table 1. Baumans angle values in studied

groups

healthy elbow was evaluated. For statistical analysis

of data was used statistical
software SPSS 12. Statistical analysis of data was performed by descriptive statistics to calculate the mean
and standard deviation, and
Figure1. Bauman's angle values
Figure1. Baumans angle values
t-test and test to calculate
the significance of the established results. Statistical
analysis was performed with
a confidence interval of 95%,
a value of p <0.05 was considered significant.

4. RESULTS

The study involved two

groups of 30 patients each.
Baumans
and
fragment
Figure
2. Bauman'sangle
angle and
distaldistal
fragment
dislocation dislocation
The first group of patients Figure 2.
Figure 2. Bauman's angle and distal fragment dislocation
underwent surgery to 24 after injury (group 1), there
were 20 boys and 10 girls,
and the second group underwent surgery after 24 h
of injury (group 2) and there
were 19 boys and 11 girls (p =
0.37) . The average of the first
Figure 3. Loss of caryying angle of injured elbow in studied groups
group was 7.16 2, 46, and
another group of subjects
7.23 2.81 years (p = 0.46).
In both groups the largest
elbow
in in
studied
number of respondents be- Figure
Figure3.3.Loss
Lossofofcaryying
caryyingangle
angleofofinjured
injured
elbow
studied groups
groups
longed to a life sentenced to
six to ten years. Regard to
position of the distal fragment in both mean carrying angle of the healthy elgroups there is higher number of re- bow in the first group was 14 1.36 ,
spondents with posteromedial dislo- and in the second group 14.43 0.89
cation of the distal fragment (p = 0.14). (p = 0.07). Loss of carrying angle of the
In both groups more of respondents
had a fracture of the left humerus (p =
0.1), which was mostly non dominant.
Measurement of Baumans angle on the
anteroposterior view in both groups
showed no statistically significant difference in their values (p = 0.37) (Table
1). In both groups the majority of respondents had a value of Baumans angle 70-80 (Figure 1). Increase of Baumans angle in both studied groups Figure 4. Correlation in Baumans and carrying
Figure 4. Correlation in Bauman's and carrying angle on injured elbow
mostly occurs in posteromedial dislo- angle on injured elbow

Med Arh. 2013 Jun; 67(3): 195-197 original paper

Correlation Between Baumans and Carrying Angle in Children with Supracondylar Fracture of Humerus

Baumans angle that was

measured immediately after repositioning and carrying angle that was measured
in the postoperative followup. He concluded that the
measurement of the Baumans angle after the repositioning can be used for estimating of the final carrying angle, which is imporFigure
5. Correlation
between
Baumans
angle
deviation
andand loss of carrying angle
Figure
5. Correlation
between
Bauman's
angle
deviation
tant for the prevention of
loss of carrying angle
cubitus varus (9). Silva et al.
injured elbow in the first group was 4.30
conducted a study in 2010th
7.66 , and the second group 5 6.11 and they examined the Baumans an (p = 0.35) (Figure 3). In both studied gle in 35 children with supracondygroups there was a negative correlation lar fractures. They concluded that the
between Baumans and carrying angle Baumans angle is simple, easily meaof injured elbow (r = -0.543, p <0.0001) surable and reliable indicator that can
(Figure 4). Analyzing deviation of Bau- be used to assess the outcome of supramans angle from the value of 75 with condylar fractures in children (10). Bethe loss of carrying angle a significant sides Baumans angle which is used to
positive correlation between the devia- evaluate the adequacy of fracture retion Baumans angle and loss of carry- duction, measuring of carrying angle is
ing angle was noticed (Figure 5).
performed, and it is used to evaluate the
success of treatment. Changes in carry5. DISCUSSION
ing angle after supracondylar fractures
Supracondylar fractures of the hu- occur as a result of inadequate anatomimerus are the most common type of cal reconstruction due to loss or reposielbow fracture in children and adoles- tioning, and may also be due to disturcents and accounts for 16% of all frac- bances in the growth of the distal end
tures in childhood. In 60% of cases the of the humerus (11, 12). Worlock confracture is on the left, usually the non ducted a study that examined the cordominant hand (8). Dislocated supra- relation of Baumans and carrying ancondylar fractures can lead to serious gle on the uninjured, and the same anresidual deformity if they are not re- gles on the injured arm. This study has
duced and stabilized in the optimum shown a direct correlation in Baumans
position. The goal of treatment is to and carrying angle. With increase of the
achieve and maintain the anatomic Baumans angle there is decrease in the
location of the fractured fragments, value of carrying angle on the healthy
which leads to rapid recovery with the and the injured arm (13). Measurement
return of full and unrestricted function of Baumans angle after supracondylar
with minimal risk of complications. Af- fracture reduction is a good indicator
ter making the stabilization the goal is of the final value of carrying angle into preserve the position of fractured jured arm, and thus of the potential ocfragments since the loss of reduction currence the angular deformity.
leads to changes of carrying angle and
In our study, in both studied groups,
to possible occurrence of cubitus varus. postoperative anteroposterior X-rays of
Adequacy of supracondylar fracture re- the injured elbow were made and the
duction is observed on anteroposterior Baumans angle was measured (). Reand profile view of elbow. Baumans an- ciprocal angle (90-) is approximately
gle is a good indicator of the adequacy equal to the carrying angle, which is
of repositioning. This is based on the measured by goniometer. Correlation
assumption that Baumans angle is in of reciprocal angle on the anteroposteconstant relation to the carrying angle rior image and carrying angle measured
in dislocated fractures.
with goniometer was used in our study.
Dai conducted a study in 1999 and
After the carrying angle on healthy
found a significant correlation between elbow was measured, Baumans an-

gle value on the healthy elbow was assessed, and as a good anatomical reconstruction of the injured elbow fractures considered value of Baumans angle 75 5 .
Based on the average values we
assessed that in both groups adequate
anatomical reposition was mostly
achieved.

6. CONCLUSION
Baumans angle measurement is important for assessing the adequacy of
supracondylar fracture reduction. Baumans angle correlates well with the carrying angle and can be used as an indicator of the potential occurrence of cosmetic complications. Carrying angle of
uninjured arm measured when reviewing a child who has suffered supracondylar fracture, can serve as a useful parameter in the assessment of real Baumans angle, and thus the adequacy of
repositioning the injured hand.

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