Delayed percutaneous pinning after emergency manipulative reduction and plaster fixation for type III supracondylar fractures of humerus in children

Abstract

Objective To investigate the method and necessity of delayed percutaneous pins fixation for type Ⅲ supracondylar fractures of humerus in children after emergency manipulative reduction and plaster fixation.Methods From February 2008 to February 2013,the clinical data of 189 patients with Gartland type Ⅲ supracondylar fractures were reviewed.They underwent delayed percutaneous pinning after emergency manipulative reduction and plaster fixation.There were 118 males and 71 females with a mean age of 6.8 (2-13) years.The average delay between injury and emergency reduction and plaster fixation was 4.8 (0.5-8) hours.Fracture displacement significantly improved after manipulative reduction,including satisfactory reduction (n =115).Then all cases were hospitalized.After preparation for a mean length of 3.8 (0.5-8) days,delayed percutaneous Kirschner wire fixation was performed.Postoperative elbow 90 plaster fixation was applied.Plaster,pins and Kirschner wire were removed after 3-4 weeks.The mean postoperative follow-up period was 12 (3-48) months.Results The mean pain VAS scores decreased from (6.8 ± 2.3) to (3.2 ± 1.2) points.And the mean operative duration of closed reduction and percutaneous pinning fixation was 21.4(10-45) min.All fractures healed without compartment syndrome or ischemic contracture.Among 4 cases of mild cubitus varus,one case of serious elbow varus required surgery after 2 years.And 24/25 cases of preoperative nerve injury fully recovered while one case of ulnar nerve injury had incomplete recovery.Postoperative ulnar nerve injury was restored in 2 cases after 3 months.Conclusions The treatment of delayed percutaneous pin fixation for children type Ⅲ supracondylar fractures after manipulative emergency reduction and ultra-early plaster fixation can relieve pain,improve the success rate of delayed surgery and reduce extremity swelling and complications.It is an effective solution to the controversy of emergency versus non-emergency surgery for supracondylar fractures in children. Key words: Humeral fractures; Manipulation, orthopedic; Fracture fixation