Abstract
Aim: The treatment protocol for supracondylar humeral fracture has mainly been based only on the severity of displacement and percutaneous pinning has been recommend as a first treatment. However, a long oblique fracture line is difficult to fix by the traditional cross pinning. The purpose of this study is to assess the prevalence of high-long oblique supracondylar humeral (HLO) fracture and evaluate the surgical outcome of percutaneous pin fixation.Methods: We reviewed 690 children who had undergone an operation for the displaced supracondylar humeral fracture. HLO fracture was defined as having a fracture line starting from either cortex above the metaphyseal-diaphyseal junction and finishing at the opposite cortex around or below the olecranon fossa. Clinical and radiographic parameter outcomes were assessed.Results: There were 14 patients diagnosed with the HLO fracture (14/690) and all the patients were treated by pin fixation. The median age was 5 years 1 month (range, 2–11 years). The common mode of injury was direct contact injury to the elbow. There were 6 patients with lateral HLO fracture, and 8 patients had medial HLO type. In medial HLO type, medial pinning only was done in 3 patients due to the difficulty in lateral pin insertion. In addition, the lateral pin was not a bicortical fixation through capitellum entry in 2 patients who had it fixed by cross pinning. The final Baumann angle and lateral humero-capitellar angle were 20.5 (5–67.6) degrees and 49.3 (23.3–71.9) degrees, respectively, without statistical significance compared to the normal side. Flynn's cosmetic grade showed satisfactory results in all patients.Conclusion: The prevalence of HLO fractures was 2% in the displaced supracondylar humeral fracture. The mechanism of injury of HLO fractures may be direct contact injury. In medial HLO fractures, medial pinning is important for stability, and sometimes lateral pinning was impossible. Contrarily, lateral HLO fracture could easily be fixed by lateral-only pinning, but the correct lateral pinning is necessary because medial pinning is difficult. The HLO fracture is a difficult pattern to treat by traditional percutaneous pinning and another surgical option should be considered.
Highlights
Supracondylar humeral fracture is the most common elbow fracture in children, and the treatment protocol has mainly been based on the severity of displacement [1,2,3]
The displaced supracondylar fracture (Gartland type III or IV) has been defined as a fracture of the metaphyseal region of the distal humerus with the fracture line crossing both medial and lateral columns without involving the intercondylar region, and numerous orthopedic surgeons still believe that the appropriate treatment for the displaced pediatric supracondylar humeral fracture would be percutaneous pinning and cast immobilization after closed or open reduction
Between January 2000 and June 2020, we reviewed 719 children with supracondylar humeral fractures operated at a single tertiary pediatric care hospital
Summary
Supracondylar humeral fracture is the most common elbow fracture in children, and the treatment protocol has mainly been based on the severity of displacement [1,2,3]. Elastic stable intramedullary nailing for high supracondylar MDJ fractures have been reported due to the difficulty in achieving bicortical fixation with Kirschner wires (K-wires) [5, 9,10,11]. Lateral external fixator, another surgical option, has demonstrated superior outcome for oblique or comminuted fracture [6]. The traditional percutaneous pinning for the pediatric supracondylar fracture should be modified based on more precise classification and diverse treatment methods, not just on the severity of displacement [4, 8, 9]
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