Fractures Of Humerus In Children Research Articles

Close Reduction of Supracondylar fracture of humerus in children by Gravity Method

Objective: To evaluate the outcomes of employing a new technique, the gravity method, for the closed reduction of supracondylar humerus fractures (Gartland’s type II and III) in pediatric patients treated at the Trauma Center of Aziz Bhatti Shaheed Hospital Gujrat. Methodology: This descriptive cross-sectional study was conducted at Aziz Bhatti Shaheed Hospital's Trauma Center from August 2022 to April 2023. Children under 12 years old, presenting within 48 hours of injury with closed supracondylar humerus fractures (Gartland’s Extension type II and III), were included. All patients underwent closed reduction and percutaneous pinning. Data analysis was performed using SPSS, employing means and standard deviations for quantitative variables, and frequency and percentage for qualitative variables. Results: The mean age was 5.5 years (±1.5). Among 65 patients, there were 45 males and 20 females, with a male-to-female ratio of 1:0.4. The right humerus was affected in 28 patients (43%), while the left humerus was affected in 37 patients (57%). The gravity method successfully reduced 90% of fractures without the need for an assistant surgeon, resulting in a zero percent incidence of iatrogenic neurovascular injury. The average surgical duration was 20 minutes (ranging from 16 to 24 minutes), with an average of 7 images captured using the image intensifier. In cases where the gravity method failed, alternative closed reduction methods were employed for 10% of fractures; no open reduction was necessary. Conclusion: The gravity method demonstrates safety and efficacy by providing accurate traction for reducing displaced supracondylar fractures without causing damage to the overlying skin or neurovascular structures around the elbow. Its applicability is particularly noteworthy in settings with a shortage of trained medical personnel and limited expertise in managing neurovascular complications.

Use of paralytic agents during the operative treatment of type III supracondylar humerus fractures in children: A single-center investigation and survey of Pediatric Orthopaedic Society of North America members

BackgroundParalytic agents are occasionally used during the surgical treatment of type III (OTA 13A2) supracondylar humerus fractures (SCHFx) in children depending on surgeon preference. Paralytic agents create a neuromuscular blockade and therefore may potentially help with ease of fracture reduction. Controversy regarding the use of a paralytic agent as an adjunct to anesthesia exists due to potential associated adverse drug reactions, including prolonged paralysis, cardiovascular effects, or electrolyte abnormalities.The purpose of this study was to investigate intraoperative paralytic use in pediatric type III SCHFx and to report survey responses of members of the Pediatric Orthopaedic Society of North America (POSNA) on paralytic use in SCHFx management. MethodsA retrospective chart review identified 319 type III SCHFx treated at our institution (January 2016-May 2019). Patients were assigned to three groups: Group 1, surgical treatment without a paralytic agent (n=240); Group 2, treatment with rocuronium (n=43); Group 3, treatment with succinylcholine (n=36). POSNA members were surveyed regarding paralytic use intraoperatively for type III SCHFx (November–December 2021) on paralytic use frequency, request for paralytics, reversal agent use, average time to surgery after injury and/or presentation, effect of time to surgery after injury and/or presentation on when to use a paralytic, annual number of SCHFx surgeries performed, awareness of paralytic complications, and years of surgeon experience. Statistical analysis was performed. ResultsAverage patient age was 5.2±2.2 years. Group 2 had significant increases in anesthesia duration, surgical duration, fluoroscopic time, and radiation exposure compared to Group 1. Group 2 had a higher conversion rate to open reduction than other groups. No statistically significant difference was found among groups in terms of sex, body mass index (BMI), laterality, radiographic measurements, or rates of open procedures or complications. Survey results indicated 32% (24/76) routinely use paralytics during closed reduction maneuvers; 71% (17/24) request administering paralytics at the beginning/before the case; and 33% (8/24) use paralytics in all type III SCHFx. ConclusionsSurgeons at our center reported paralytic use for closed reduction in 25% of patients; similarly, one-third of POSNA survey respondents reported paralytic use during operative management. Although paralytic agents are used during the treatment of supracondylar humerus fractures in children this study was unable to demonstrate an association of advantageous outcomes, such as shorter surgical times. Routine paralytic use to facilitate closed reduction of supracondylar humerus fractures in children warrants further study. Level of EvidenceLevel III, Retrospective chart review; Therapeutic study

Fixation of Lateral Condyle Humerus Fractures in Children by Terminally Threaded Screws

Fixation of Lateral Condyle Humerus Fractures in Children by Terminally Threaded Screws

Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children.

The purpose of the study was to compare the efficacy of conservative and surgical treatments for Gartland type II supracondylar humerus fractures in children. We assessed 142 patients with type II supracondylar humerus fractures treated in our hospital from February 2018 to February 2019. The patients were divided into two groups: initial conservative treatment (Group A) and initial surgical treatment (Group B). Clinical outcomes were measured by the Flynn scoring system. Variables were analyzed using a statistical approach between those groups. All patients were followed up for 6-12 months. The rate of loss reduction was 19.8% in patients treated conservatively, and the incidence of pin infections was 7.1% in patients treated surgically. Although there were no statistical differences between the three groups in fracture healing time and Flynn score, the conservative treatment was superior to surgical treatment in functional recovery times. At the last follow-up, all fractures had healed without iatrogenic vascular or nerve injury, Volkmann's contracture, or cubit varus deformity. Conservative treatment is safe and effective for the treatment of Gartland type II supracondylar fracture and represents a faster recovery time of elbow range of motion as compared with surgical treatment. Type IIB had a 41.3% risk of secondary displacement versus 5.3% for IIA, but we still prefer closed reduction. However, closed reduction of Garland type II must be followed accurately in the first 2 weeks to identify patients with loss of reduction. The patients who loss reduction can be treated with percutaneous pinning, and the clinical effect was consistent with immediate surgical treatment. Level of evidence: level III.

Early Lateral Closing Wedge Surgical Correction of Cubitus Varus Deformity Complicating Supracondylar Humeral Fracture in Children

Cubitus varus deformity complicating supracondylar fracture of humerus in children usually implies a malunion from inappropriate treatment of the fracture . The resulting deformity can be solved only by osteotomy ,since the deformity once established it will not correct by remodeling . A lot of controversy is still present regarding the best age of the child to perform the corrective osteotomy . Cosmetic appearance is the most common indication for osteotomy

Outcomes of proximal humerus fractures in children: a retrospective cohort study.

Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs. The records of the Women's and Children's Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome. Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically. The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.

PERCUTANEOUS PINNING VERSUS OPEN REDUCTION K WIRE FIXATION IN GARTLAND TYPE III SUPRACONDYLAR HUMERUS FRACTURE IN CHILDREN

This study was carried out to explore the percutaneous pinning versus open reduction K wire fixation in Gartland Type III supracondylar humerus fractures in children. This randomized control trial was conducted at the Department of Orthopaedic and Trauma DHQ Hospital Timergara Lower Dir KPK Pakistan hospital from September 2022 to November 2023. Eighty-four patients participated in this study, which was distributed into two groups. The open reduction and percutaneous pinning groups contained 42 patients each. Both groups were assessed for enhancement in function and radio-logically for fracture union. Children of both genders with Gartland type III supracondylar fractures between the ages of 2 and 12 years were included. In contrast, all children with open fractures, multiple fractures, and systemic diseases like infections such as pneumonia and individuals with cancer were excluded. In the group receiving percutaneous pinning, 33 (78.5%) children had excellent functional outcomes, 7 (16.6%) showed good functional outcomes, and 2 (4.7%) showed fair functional outcomes. In the open reduction group, there were 27 (64.3%) children with excellent functional results, 10 (23.8%) with good functional outcomes, 3 (7.1%) with fair outcomes, and 2 (4.7%) with poor functional consequences (p > 0.05). When treating children with Gartland type III supracondylar fractures of the humerus, percutaneous pinning is the safest and most successful method than open reduction with K wire fixation. Its apparent operative scars and other consequences are modest.

Research: Construction and validation of elbow function prediction model after supracondylar humerus fracture in children

This article’s objectives are to develop a model to predict children’s recovery of elbow function following supracondylar fracture, analyze the risk factors affecting those children’s elbow function after surgery, and propose a individualized treatment strategy for elbow function in various children. We retrospectively analyzed clinical data from 410 children with supracondylar humerus fracture. A modeling set and a validation set of kids in the included studies were arbitrarily split into 2 groups on a 7:3 basis. To identify statistically significant risk factors, univariate logistic regression analysis was used. Then, multivariate logistic regression was used with the risk factors, and the best logistic regression model was chosen based on sensitivity and accuracy to create a nomogram; A total of 410 children were included in the study according to the inclusion criteria. Among them, there were 248 males and 162 females, and the fracture type: 147 cases of type IIb and 263 cases of type III. There were no significant changes in the afflicted limb’s lateral difference, surgical method, onset season, and number of K-wires, according to univariate logistic regression analysis. Age (P < .001), weight (P < .001), height (P < .001), preoperative elbow soft tissue injury (OR = 1.724, 95% CI: 1.040–2.859, P = .035), sex (OR = 2.220, 95% CI: 1.299–3.794, P = .004), fracture classification (Gartland IIb) (OR = 0.252, 95% CI: 0.149–0.426, P < .001), no nerve injury before surgery (OR = 0.304, 95% CI: 0.155–0.596, P = .001), prying technique (OR = 0.464, 95% CI: 0.234–0.920, P = .028), postoperative daily light time > 2 hours (OR = 0.488, 95% CI: 0.249–0.955, P = .036) has a significant difference in univariate analysis; Multivariate regression analysis yielded independent risk factors: fracture classification; No nerve injury before surgery; The daily light duration after surgery was > 2 hours; soft tissue injury; Age, postoperative cast fixation time. The establishment of predictive model is of significance for pediatric orthopedic clinicians in the daily diagnosis and treatment of supracondylar humerus fracture.

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years.

To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.

Outcome of Closed Reduction and Percutaneous Cross K-Wire Fixation of Supracondylar Fractures of Humerus in Children

Background: Supracondylar fractures of humerus are common skeletal injuries in paediatric age group in between 50-70% of elbow injuries. They are often associated with complications and are very notorious for neurovascular injuries between 5 to 9 years of age. Objective: To evaluate the outcome of supracondylar fracture of humerus with closed reduction and percutaneous cross k-wires fixation. Materials and method: A prospective study of 30 patients of Gartland type III fractures admitted in the orthopaedics department of 250 Bedded General Hospital, Tangail from January 2021 to December 2021. Results: Regarding FLYNN CRITERIA, there were 24 excellent, 3 good,2 fair, and 1 poor results. Fair and poor results were due to poor compliance to follow-up and postoperative rehabilitation. There were 4 cases with pin tract infection, 1 with elbow stiffness, and 1 with cubitus varus. Conclusion: Closed reduction and percutaneous cross k-wire fixation is a very effective and minimally invasive way of treatment of displaced supracondylar fractures of humerus. Crossed K-wire biomechanically better way of the stability of fracture reduction J Shaheed Suhrawardy Med Coll 2022; 14(1): 16-19

Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children

Aim and objectiveTo compare the clinical effect of reconstruction of internal and lateral column periosteal hinge-assisted treatment with Kirschner wire and internal fixation with Kirschner wire in the treatment of multidirectional unstable supracondylar fractures of humerus in children.MethodsA retrospective cohort study was conducted to analyze the clinical data of 48 patients (31 male, 17 female; mean age: 6.7 ± 2.4 years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. Twenty-five cases were treated with Kirschner wire reconstruction of the internal and lateral column periosteal hinge assisted by closed reduction and Kirschner wire internal fixation (study group). Twenty-three cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction, fracture healing time, Baumann angle (BA), shaft-condylar angle (SCA), range of motion (ROM), and Flynn score of elbow at the last follow-up were compared between two groups. Complications such as infection and irritation of Kirschner wire tail were observed in two groups 2 months after the operation.ResultsAll patients were followed up for 10–22 months ([13.85 ± 2.89] months). The average operation time of the control group was 82.1 min, which was significantly longer than that of the study group 32.3 min (P < 0.05). The number of intraoperative fluoroscopy (29.4 ± 9.2) in the control group was significantly higher than that in the study group (15.2 ± 6.3) (P < 0.05). The incision rate of the control group was 17% while that of the study group was 0 (P < 0.05). According to Flynn score, the excellent and good rate of the elbow joint in the control group was 86.9% (20/23). The excellent and good rate of the elbow joint in the study group was 92.0% (23/25) (P > 0.05). There was no significant difference in fracture healing time, BA, SCA, and ROM between the two groups (P > 0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up.ConclusionReconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time and reduce intraoperative fluoroscopy times and incision rate.

Treatment outcomes analysis in supracondylar humerus fractures in children and adolescents

Background. Distal epimetaphyseal humerus fractures in children and adolescents are relatively common injuries, with supracondylar and transcondylar fractures being the most prevalent. Among injuries to the distal humerus, these fractures occur most frequently and are one of the most common household injuries, composing 47.5–80 % of all intra-articular fractures of the elbow in children aged 3–12 years. Poor treatment outcomes range from 6.67 to 18.2 %. The aim is to study a current stage and therapeutic challenges in supracondylar humerus fractures in children and adolescents, and to find out optimal management based on analysis of the long-term treatment outcomes in this category of patients. Materials and methods. A retrospective study of treatment outcomes was conducted in 123 patients with supracondylar humerus fractures in 2019–2021. Average age of patients was 7.38 ± 0.34 years. Targeted clinical and instrumental examination have been performed in all patients. Fracture type was assessed based on AO Pediatric Comprehensive Classification of Long-Bone Fractures (PCCF). Mayo Elbow Performance Score was used to evaluate treatment outcomes. Results. Determining the type of supracondylar humerus fractures using AO PCCF compared to Gartland classification is justified as it allows for a more detailed assessment of the injury, thereby expanding the possibilities for developing individualized treatment strategies. Poor treatment outcomes with reduction + external immobilization constitute 3.7 % of cases, closed reduction + percutaneous fixation + external immobilization — 6.1 %, open reduction + pin fixation + external immobilization — 8.8 %. Conclusions. Supracondylar fractures are one of the most frequent injuries to the distal humerus and mostly occur in boys aged 4 to 9 years (58.3 % of cases). Fractures type II.1 (boys/girls ratio is 33.3/37.3 %) and III.1 (23.7/27.6 %) are dominating. Deepening the knowledge through anatomical and biomechanical studies of the structures with crossed and coronal pins will improve the existing fixation devices and will become the basis for the development of new ones, which will significantly improve treatment outcomes in supracondylar humerus fractures in children and adolescents.

Fractures around the shoulder in the skeletally immature: A scoping review.

Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 - 2/3 shaft width) in the current literature.

Comparative study on effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in treatment of Jakob type Ⅱ lateral condylar humerus fractures in children

To compare the effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ lateral condylar humerus fracture (LCHF) in children. A clinical data of 101 children with Jakob type Ⅱ LCHF, who met the selection criteria and were admitted between April 2021 and April 2022, was retrospectively analyzed. Of them, 47 cases were treated with ultrasound-assisted Kirschner wire fixation (group A), and 54 cases with arthrography-assisted surgery (group B). There was no significant difference in gender, age, cause of injury, fracture side, and disease duration between groups (P>0.05). Intraoperative fluoroscopy times, operation time, and hospital stay, Flynn elbow joint function score, and postoperative complications were recorded and compared between groups. X-ray examination was performed to observe the healing of fracture, and measure the carrying angle and the shaft-condylar angle (SCA). The success rate of closed reduction was significantly higher in group A than in group B (P<0.05), and the intraoperative fluoroscopy times was significantly less in group A than in group B (P<0.05). There was no significant difference in operation time and hospital stay between groups (P>0.05). All children in both groups were followed up 12-18 months, with an average of 13.6 months. X-ray reexamination showed that the fractures of both groups healed, and the difference in healing time was not significant (P>0.05). At last follow-up, there was no significant difference in carrying angle and SCA between unaffected side and affected side in both groups and between groups A and B in affected side (P>0.05). There was no significant difference in Flynn elbow joint function score between groups (P>0.05). There were 18 cases of lateral spurs formation in group A, 1 case of pinning infection and 26 cases of lateral spurs formation in group B, and there was no significant difference in the incidence of the above complications (P>0.05). Compared with the arthrography, the ultrasound-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ LCHF in children can avoid the open reduction and decrease the number of intraoperative fluoroscopy, and obtain the good effectiveness.

Clinical and radiological evaluation of surgical treatment of medial epicondyle fractures of humerus in children. A two-centre study

The present study analyses the outcome of open reduction and internal fixation (ORIF) of humerus medial epicondyle fracture with the use of Kirschner (K) wires, and determine the effect of elbow dislocation. The study included 112 patients operated on in 2005–2016. Of these, 81presented with an isolated medial epicondyle fracture (mean age 11.6 years), and 31 with an elbow dislocation (mean age 11.9 years). Out of 112 patients tested, 98 achieved an excellent treatment result, ten good and a mean Mayo Elbow Performance Score (MEPS); no significant differences were observed between dislocated and non-dislocated elbow groups. Those with an isolated medial epicondyle fracture demonstrated a mean flexion of 140.7° and extension deficit of 3.0°, while those with an elbow dislocation displayed a mean flexion of 134.5° and extension deficit 6.1°. The dislocation group demonstrated significantly greater extension and flexion deficits (p = 0.019, p < 0.001, respectively). One patient required revision surgery due to nonunion. Ulnar nerve function was normal in 110 patients: in the other two, it resolved spontaneously in one, and the nerve was transposed in the other. Medial elbow instability was found in seven patients: two with elbow dislocation and five without. ORIF with K wires is a safe procedure for treating medial epicondyle humeral fractures that yields good or very good results. Similar outcomes are observed between patients with and without dislocation according to MEPS; however, flexion and extension are more limited in the former group.

Influence of Obesity in Children with Supracondylar Humeral Fractures Requiring Surgical Treatment at a Tertiary Pediatric Trauma Center.

Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children's health and society as a whole. The main objective of this study was to determine whether obesity has an effect on the severity of supracondylar humerus fracture in children, regardless of whether it is a low- or high-energy trauma. The electronic records of patients treated for the supracondylar fracture of the humerus in the ten-year period from 1 January 2013 to 1 January 2023 were reviewed retrospectively. In the observed period, 618 children, including 365 (59.06%) boys and 253 (40.94%) girls, were hospitalized and treated surgically with the diagnosis of supracondylar fracture. The distributions according to the observed parameters were as follows: age (months) = 88.18 ± 32.64; height (cm) = 123.42 ± 16.83; weight (kg) = 27.18 ± 11.32; body mass index = 17.18 ± 3.06; body mass index-for-age percentile = 57.34 ± 32.11. Overall, 141 (22.82%) fractures were classified as Gartland II, while 477 (77.18%) were classified as Gartland III. A total of 66 (10.68%) fractures were flexion type, while 552 (89.32%) were extension type. The left elbow was affected in 401 (64.89%) children, while the right was affected in 217 (35.11%) children. The main mechanism of injury was a fall at ground level (33.33%). In relation to gender, a statistically significant difference was recorded in body mass index and percentile (p < 0.05). According to Gartland, the proportion of children below and above the 85th percentile in relation to the type of injury was statistically significant (p < 0.05). It was determined that the energy level does not significantly influence the injury's severity: p(GII) = 0.225; p(GIII) = 0.180. In our study, we found that the proportion of overweight and obese children requiring surgical treatment was higher in Gartland type III injury, so there is no doubt that as a society we must prevent further increases in the prevalence of childhood obesity for this reason as well.

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children

To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

Comparison of Outcome of three Different Approaches for Supracondylar Humerus Fractures in Children

Introduction Supracondylar humerus is one of the most common elbow fractures in children. It accounts for about 60% of all the elbow fracture. It is a challenging orthopedic presentation. It is more common in the children younger than 15. The bending structure and weak metamorphic sclerotin of distal humerus are the underlying cause behind these fractures. Fractures are classified according to the Gartland’s criteria. Study design: It is a retrospective study conducted at Sahara Medical College, Narowal and Pakistan Railway General Hospital, Rawalpindi for duration of six months from August 2022 to January 2023. Material and Methods: The patients were aware of the study objective. The demographic features of each selected patient were recorded. There were total 150 patients included in this study. Patients were divided into three groups on the basis of type of approach used for the treatment of supracondylar humerus fracture; lateral approach, medial approach and posterior approach as group A, B and C respectively. Results: The average age of patients was 7.61±4.5, 7.2±3.6 and 6.5±4.5 years for group A, B and C respectively. The reason of fracture was determined and the data revealed that most of the injuries were related to sports. P value was calculated and the data was statistically significant. Conclusion: Our results suggest that as compared to posterior and medial, lateral approach is better as it showed significant radiological and functional outcomes. It can be used by surgeons as it takes less time and the complications rate is lower. Keywords: lateral approach, supracondylar humerus and posterior approach.

Assessment of functional and radiological outcomes of closed reduction and K-wire fixation of supracondylar fracture of humerus in children

: Supracondylar fractures of the humerus are commonly seen in children and are difficult to manage because of their unstable nature. It is difficult to maintain the reduction with splints. Non-operative treatment is associated with malunion and open reduction is more invasive procedure. Closed reduction of the fracture with percutaneous K-wire fixation is the preferred procedure with satisfactory results. : Children who came to the tertiary care hospital with a fracture in the supracondylar region following history of trauma to the elbow region and X-ray showing Gartland Type II and extension Type III fractures were included in this study. All these fractures were managed with closed reduction and fixation with K-wires inserted by percutaneous technique. Functional outcome and radiological union were noted.: A total of 35 children were operated. About half of the study population were in the range of 6 to 8 years. Majority of study subjects were boys. The average time period between sustaining a fracture and surgical procedure was 1.35 ± 0.48 days. The final results of this treatment modality were graded based on Flynn’s criteria and about 94.28% of study subjects had excellent to good outcomes. One child had complication of superficial pin tract infection.: Displaced supracondylar fractures of humerus can be effectively managed with closed reduction and percutaneous criss-cross K-wire fixation. This procedure does not disturb the normal fracture healing process.

FUNCTIONAL OUTCOME OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURE IN CHILDREN MANAGED WITH PERCUTANEOUS PINNING - A PROSPECTIVE STUDY

Background: The majority of elbow injuries in children are supracondylar fractures of the humerus, accounting for around 60% of all elbow injuries in the rst ten years of life. Associated with complications like compartment syndrome, neurovascular damage, Volksman'sischaemic contracture and malunion. Two lateral pins or a cross pin construction are the most popular options for pinning. As compared to alternative treatment options, closed reduction and percutaneous K-wire xation are the most effective and least invasive. Complications like malunion, loss of reduction and compartment syndrome may arise from treating it conservatively. This research evaluates the functional and radiological results of closed reduction percutaneous K wire treatment for displaced supracondylar humerus fractures in children. Based on Materials and Methods: the inclusion and exclusion criteria from the consecutive sampling, 32 patients were chosen for the research. All patients had percutaneous K wirexation using the usual procedure. 20 children (63%) of them were affected in their rs Results: t decade of life, with a clear male predilection than females. Mayo elbow scoring was 2.5, 6.0 and 3.75 at 6 weeks, 3 months and 6 months. PTI and Cubitus Rectus was noted in 8 and 2 respectively in our study population. Clinical outcomes measured by Flynn criteria was poor in 2 cases, satisfactorily excellent in 28 and satisfactorily good in 2 case. Closed reduction and percutaneous pinning either by crossed conguration or by latera Conclusion: l pinning is the treatment of choice for paediatric supracondylar humerus fractures. Regardless of the conguration, the proper pinning method guarantees a successful result. Closed reduction and percutaneous pinning is a safe, cost-effective, less morbid procedure.