Supracondylar Humeral Fractures Research Articles

Double Fluoroscopy Techniques for Closed Reduction and Percutaneous Pinning in Pediatric Supracondylar Humeral Fractures: Fluoroscope Positioning and a Case Series

Objective: Percutaneous pinning for supracondylar humeral fractures (SHFs) requires precise pin insertion while maintaining reduction making fluoroscopy indispensable for this procedure. However, it is currently difficult to obtain good-quality two-directional images with one fluoroscopy. This study aimed to report the outcomes of a closed reduction and internal fixation technique using 2 fluoroscopes simultaneously for pediatric SHF. Patients and Methods: Thirty-eight children were identified as having SHF (aged <16 y) who underwent closed reduction and percutaneous pinning. Regarding fracture type (Gartland classification), 10 patients had type II fractures, and 28 patients had type III fractures. The first fluoroscope used for the anteroposterior view was positioned from the patient’s cephalad side. The second fluoroscope used for the lateral view was positioned from the patient’s caudal side. By arranging 2 fluoroscopes from the craniocaudal side, it was possible to secure sufficient standing space for operators who maintained the reduction and inserted the pins. Results: Although this method was intricate and time-consuming for preoperative positioning during fluoroscopy, it was possible to monitor accurate images in 2 directions simultaneously during surgery. Consequently, we were able to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction. There were no complications. Conclusion: Procedures using 2 fluoroscopes simultaneously make it possible to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction.

Zero-incision treatment of supracondylar humeral fractures in extremely unstable Gartland type Ⅳ children by percutaneous prying combined with modified rotary reduction with Kirschner wire

To investigate the clinical efficacy of percutaneous prying combined with modified rotary reduction with needle in the treatment of supracondylar fracture of humerus in Gartland type Ⅳ children, and to evaluate the postoperative elbow joint function, the incidence of elbow varus deformity and the application prospect of this technique. A total of 98 children diagnosed with Gartland type Ⅳ supracondylar humeral fractures between June 2020 and January 2023 were included in this study, comprising of 57 males and 41 females. The age ranged from 2 to 14 years old with an average of (6.24±4.76) years old. There were 48 cases on the left side and 50 on the right side. The time interval from injury to surgery ranged from 2 hours to 2 days, and emergency operation was performed in 26 cases. During the operation, the Kirschner wire was inserted bluntly into the broken end of the fracture using the lever principle, and the reduction was performed by percutaneous prying. Then the modified rotary reduction method with kirschner wire was used to close and reset the Kirschner wire internal fixation, and zero incision was achieved in all cases. Flynn score was used to evaluatal the function and appearance of the elbow joint at 6 months after operation. The operation was successfully completed by all 98 children, and they were followed up for a duration from 6 to14 months with an average of (9.82±3.51) months. The fractures in all cases healed, the time ranged from 6 to 8 weeks with an average of (6.72±1.17) weeks. The Flynn function score of the elbow joint was rated as excellent in 95 cases and good in 3 cases at the 6-month postoperative evaluation. No related complications occurred, such as cubitus varus deformity, osteofascial compartment syndrome, Kirschner wire rupture or rejection, iatrogenic vascular and nerve injury, Volkmann's contracture or ossification myositis. Percutaneous pry extraction combined with modified rotary reduction with needle in the treatment of humeral supracondylar fracture in extremely instability Gartland type Ⅳ children has the advantages of zero incision, little trauma, safety and good efficacy, and minimization of surgical trauma and scar formation. The postoperative elbow joint function recovery is good.

Application of elbow skin fold extension line in extreme elbow flexion in ulnar Kirschner wire insertion of extended supracondylar humeral fractures in children

To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups ( P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. The closed reduction rate of the study group was significantly higher than that of the control group ( P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] ( χ 2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group ( P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups ( P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group ( P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups ( P>0.05). In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.

Early Results of Supracondylar Humeral Fractures in Pediatrics treated with Dorgan&amp;#039;s Technique

Early Results of Supracondylar Humeral Fractures in Pediatrics treated with Dorgan&amp;#039;s Technique

Benefits of using the shaft condylar angle as a guide for close reduction in pediatric supracondylar humeral fractures

Benefits of using the shaft condylar angle as a guide for close reduction in pediatric supracondylar humeral fractures

Dorgan’s lateral cross pinning for displaced pediatric supracondylar fractures of the distal humerus

Background: Supracondylar humeral fractures are the most common elbow fracturesseen in children. Although closed reduction and percutaneous pin fixation is the treatment of choice for displaced supracondylar fractures of the humerus in children, controversy about which pin configuration is best in treating these fractures is ongoing. Some advocate lateral entry pins only while others advocate medial and lateral entry pins. In this study I utilized Dorgan’s cross lateral technique to fix such fractures which is believed to have the advantages of both the conventional pinning techniques. Objectives:To evaluate the functional and cosmetic outcome and complications of cross lateral pinning. Methods: Thirty cases of supracondylar humeral fractures were treated by closed or open reduction with cross lateral pin fixation under fluoroscopic guidance. The elbow was immobilized for a period of 4 weeks after which the pins were removed and physiotherapy initiated. At the end of 12 weeks the patients were evaluated clinically and radiologically and final results were assessed as per Flynn’s criteria. Results: According to Flynn’s criteria, the cosmetic result in my study was evaluated as excellent in 25 cases (83%) and good in 5 cases (17%) and functional result was evaluated as excellent cases in 23 (77%) and good in 7cases (23%). There were no cases of post operative loss of reduction of fractures. Six cases (20%) had pin tract infection while 24 patients (80%) had no complications at all. Conclusions: Cross lateral method of pinning for treating supracondylar fractures is a useful method of fixation as it gives stabilization like medio-lateral pinning and minimizes the risk of injuring the ulnar nerve like lateral pinning.

PREDICTORS OF ROTATIONAL FAILURE IN PAEDIATRIC SUPRACONDYLAR HUMERAL FRACTURES

Lateral-entry wiring (LEW) for displaced supracondylar humeral fractures (SHFs) has been popularised internationally. BOAST guidance suggests either LEW or crossed wires; the latter has reported lower risk of loss of fracture reduction –we explore technical reasons why.We reviewed 8 years of displaced SHFs in two regional centres. Injuries were grouped using the Gartland Classification, with posterolateral or posteromedial displacement assessment for Gartland 3 injuries. We identified any loss of fracture reduction, and reviewed intra-operative imaging to identify learning points that may contribute to early rotational displacement (ERD).345 SHFs were included, between 2012 and 2020. Gartland 2 (n=117) injuries had a 3.42% risk. ERD. Gartland 3 crossed wirings (n=114) had a 6.14% risk of ERD, with those moving all being posterolaterally displaced. Gartland 3, posterolaterally displaced LEW (n=56) had a 35.7% risk of ERD. Gartland 3, posteromedially displaced LEW (n=58) had a 22.4% risk of ERD. All injuries with ERD except 3 had identifiable learning points, the commonest being non-divergence of wires, or wires not passing through both fracture fragments.LEW requires divergent spread and bicolumnar fixation. Achieving a solid construct through this method appears more challenging than crossed wiring, with rates of ERD 3–5× higher. Low-volume surgeons should adhere to BOAST guidelines and choose a wiring construct that works best in their hands. They can also be reassured that should a loss of position occur, the risk of requirement for revision surgery is extremely low in our study (0.3%), and it is unlikely to affect long term outcomes.

Our experience with a modified prying-up technique for closed reduction of irreducible supracondylar humeral fractures

Satisfactory reduction of some displaced pediatric supracondylar humerus fractures is not achievable via closed reduction, thus necessitating open procedure, which increases the incidence of complications. Using percutaneous prying-up technique to assist closed reduction may reduce the requirement for transform to an open operation. We retrospectively reviewed displaced pediatric supracondylar humerus fractures treated by the same surgeon from September 2021 to January 2024,with 134 subjects meeting criteria for inclusion. These children were divided into two groups. In Group A(n = 61),the prying-up technique was used to assist with closed reduction of fractures. Group B(n = 73) included fractures treated with conventional manual traction. To balance group size,12 fractures from group A were randomly removed, leaving a final 61 patients in each group. Demographics, operative time, the rate of failed closed reduction, complications and radiographic results were analyzed. The operative time was significantly less in Group A as compared with Group B(mean difference, − 7.22; [95% confidence interval (CI), − 8.49 to − 5.94]; p < 0.001). The rate of failed closed reduction were significantly lower in Group A as compared to Group B(2 of 61 vs. 10 of 61, p = 0.015).However, we found no difference in terms of the radiographic results and complications between the two groups(p > 0.05). percutaneous prying-up technique significantly improves the efficiency of surgery and reduces rate of failed closed reduction of supracondylar humeral fractures in pediatric patients. Level III, retrospective comparative study.See Guidelines for Authors for a complete description of levels of evidence.

A Systematic Review and Meta-Analysis Study in Functional Outcome between Olecranon Osteotomy and Triceps Anconeous Pedicle Elevation in Intercondylar and Supracondylar Humerus Fracture

Abstract Background Approximately, 7% of all adult fractures involve the elbow, of these one third (2%) are distal humeral fractures. Articular fractures of elbow are the most difficult one to treat. Because of their complex anatomy, proximity to vital structures, injury patterns, associated osteoporosis in elderly patients and limited space for instrumentation. As far as we know, no previous meta-analysis study has investigated the privilege between olecranon osteotomy and triceps-reflacting anconeous pedicle (TRAP) regarding functional outcome and complications in the treatment of suprachondylar and interchondylar humerus fractures. Therefore, we performed this systematic review and meta-analysis study of this issue. Methods This meta-analysis study included all studies which comparing between TRAP and OO in the treatment of suprachondylar and interchondylar humerus fractures. The literature search was in the Web of Science, PubMed, Scopus, and Cochrane databases using advanced search strategy. The search results was screened using titles and abstracts then full paper. The following data were extracted: country, study design, sample size, baseline characters of included patients, intervention, outcomes, parameters measuring functional outcome as incidence of excellent and good elbow performance, Mayo elbow performance score, duration of operation, blood loss and, complications. The quality assessment was operated by ROBINS-I tool for assessment of risk of bias for non-randomized studies, cohort studies and the Cochrane RoB tool for randomized trials. Results This meta-analysis study included 10 studies. The result of meta-analysis study may be summarized as follow no statistically significant difference between operative time and blood loss during both approaches. No statistically significant difference between both approaches regarding MEPS score, DASH Score, incidence of excellent/good elbow function, supination and pronation. A significant increase in union time, extension deficit (degrees) and incidence of complications after OO approach comparing with TRAP approach. A significant decrease in ROM after OO approach comparing with TRAP approach. Conclusion TRAP approach is a better alternative to olecranon osteotomy approach in the treatment of inter-condylar and supracondylar humeral fracture. TRAP approach has privileges over olecranon osteotomy approach regarding post-operative union time, extension deficit, range of motion and incidence of complications.

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

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

Comparative risk of ulnar nerve injury in pediatric supracondylar humeral fractures: a multicenter evaluation of Kirschner wire fixation techniques.

This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation.

Animated video reduces pain and anxiety during pin removal in children with supracondylar humerus fractures: a randomized controlled trial.

The aim of this study; is to determine the level of pain and anxiety experienced by pediatric patients with operated humeral supracondylar fractures during pin removal, and to investigate the effectiveness of animated video impressions. This randomized controlled study included 180 patients aged between 4 and 12years. The patients were divided into four groups: Group 1-control; Group 2-watched the introductory animation video before the procedure; Group 3-using analgesic before the procedure (ibuprofen 10mg/kg); Group 4-watched the introductory animation video and used analgesic before the procedure. To assess pain before randomization, before-during-after procedure, and at outpatient clinic controls; the Wong-Baker Pain Scale (WBS), modified CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), and the child's heart rate were used. To assess anxiety; the Children's Anxiety Meter (CAM), The Short State Anxiety Inventory Scale (SAIS), and The Children's Emotion Management Scales (CEMS) were used. While a significant difference was detected between the groups in the tests performed at certain intervals (p < 0.001), no significant difference was detected between Groups 1-3 and Groups 2-4. The Modified CHEOPS and CEMS values obtained during the procedure showed significant variability between the groups (p < 0.001). Similarly, While a significant difference was detected between the groups in the WBS scores measured during the procedure (p < 0.001), it was observed that there was no significant relationship between Groups 1-3 and Groups 2-4 (p = 0.892, p = 0.820). Watching an introductory animated video before pin removal is an effective method to relieve the anxiety and pain felt in children with supracondylar fractures.

Medium-term clinical results in the treatment of supracondylar humeral fractures in children: does the surgical approach impact outcomes?

BackgroundRecent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other.Materials and methodsThirty-one pediatric patients treated for SCHF—19 classified as Gartland II and 12 as Gartland III—were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn’s criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn’s criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported.Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05).ConclusionsAlthough some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively.Trial registration: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute’s ethics committee (registry no. 3511).Level of evidence: Therapeutic level III

Open Reduction and Fixation of Late-Presenting Pediatric Supracondylar Humeral Fractures: A Prospective Study.

Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures. This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria. All fractures (100%) united within 3-5.5weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome. Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report

BackgroundDue to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.Case presentationA 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.ConclusionIn this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Serial Post-Operative Radiographs in Surgically Managed Pediatric Supracondylar Humeral Fractures: Are They Always Required?

Supracondylar humeral fractures are among the most common pediatric fractures that require surgical intervention when displaced. Recent attention has been directed towards the utilization of serial radiographs in the post-operative period and their effect on decision-making. This study aimed to determine the usefulness of postoperative radiographsearly post-operatively, with the goal of determining the optimal frequency for these radiographs. Pediatric patients who sustained a supracondylar humeral fracture and underwent operative intervention over a 15-year period were included in this study. Data were collected, including the baseline characteristics of the patients, fractures, and operative interventions. In addition, the time until healing, the total number of X-rays before K-wireremoval, and postoperative function were evaluated. A total of 122 pediatric patients were included, with a mean age of 5.33 ± 2.93 years. Most fractures were Gartland Type III (74.6%). Most fractures healed at 4 (36.1%) and 3 weeks (35.2%) after surgery. Of the cohort, 94.3% underwent four different x-rays before wire removal, with 4.9% requiring revision surgery. All revision cases were Gartland type 3, and for all cases, the decision to revise was made within three weeks of surgery. Routine post-fixation radiography should not be performed for surgically treated supracondylar humeral fractures before healing. An exception is the Gartland type 3 fracture, for which earlier imaging may be indicated.

Children’s orthopaedics

The June 2024 Children’s orthopaedics Roundup360 looks at: Proximal femoral unicameral bone cysts: is ESIN the answer?; Hybrid-mesh casts in the conservative management of paediatric supracondylar humeral fractures: a randomized controlled trial; Rate and risk factors for contralateral slippage in adolescents treated for slipped capital femoral epiphysis; CRP predicts the need to escalate care after initial debridement for musculoskeletal infection; Genu valgum in paediatric patients presenting with patellofemoral instability; Nusinersen therapy changed the natural course of spinal muscular atrophy type 1: what about spine and hip?; The necessity of ulnar nerve exploration and translocation in open reduction of medial humeral epicondyle fractures in children.

Cubitus varus deformity following paediatric supracondylar humeral fracture remodelling predominantly in the sagittal direction: A three-dimensional analysis of eighty-six cases

PurposeThree-dimensional (3D) capacity for remodelling in cubitus varus deformity (CVD) after paediatric supracondylar humeral fractures (PSHFs) remains unelucidated. This study investigated remodelling patterns after PSHFs by examining 3D deformity distribution over time after injury.MethodsComputed tomography (CT) data of 86 patients with CVD after PSHFs were analysed. The 3D deformity angles in the sagittal, coronal, and axial directions were assessed and correlated with the duration between the age at injury and CT evaluation. For the subgroup analysis, we performed the same correlation analysis in a younger (< 8 years old) and an older group (≥ 8 years old); we categorized the duration into early (< 2 years), middle (≥ 2 to < 5 years), and late periods (≥ 5 years) and compared the deformity angles of each direction among the three groups.ResultsSagittal deformity showed a moderate correlation with the duration of deformity (r = -0.54; P < 0.001), while coronal and axial deformities showed a negligible correlation. Sagittal deformity showed moderate correlations with the duration in the younger group (r = -0.62; P < 0.001) and weak correlations in the older group (r = -0.37; P = 0.091). In the sagittal direction, the deformity angle in the early period was significantly larger than those in the mid and late periods (P < 0.001). However, there were no significant differences among the three groups in the coronal and axial directions.ConclusionSagittal deformities in CVDs are capable of remodelling, especially in the early period and at a younger age, whereas coronal and axial deformities are less likely to undergo remodelling.

Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures.

Background and Objectives: Long-term outcomes of immediately postoperative rotational malreduction in the axial plane after operative treatment of supracondylar humeral fractures (SCHF) are unknown. This study aimed to investigate the long-term clinical outcomes and associated factors for immediately postoperative rotational malreduction of SCHF. Materials and methods: In this retrospective case-control study, 88 patients who underwent surgery for Gratland type III SCHF were enrolled between January 2012 and January 2020. Among them, 49 patients had immediately postoperative malrotational reduction (rotational malreduction group) and 39 patients had no rotational deformity (control group). To evaluate the associated factors for immediately postoperative rotational malreduction, demographic data, fracture patterns, physical examination signs, and preoperative radiological parameters were analyzed. To compare the clinical outcomes, operation time, range of motion of the elbow, time from operation to full range of motion, and Flynn criteria were evaluated. The Oxford elbow score was used to investigate long-term clinical outcomes for patients five years after operation. Results: The mean age was 5.7 ± 2.3 years and mean follow-up period was 15.7 ± 4.0 months. The rotational malreduction group had significantly more patients with oblique fracture pattern (p = 0.031) and Pucker sign (p = 0.016) and showed a significantly longer operative time (p = 0.029) than the control group. Although there was no significant difference in the range of elbow motion and the Flynn criteria, the Kaplan-Meier survival curve showed a longer time to recover the full range of elbow motion in the rotational malreduction group (p = 0.040). There were no significant differences in the long-term clinical outcomes assessed using the Oxford elbow score (p = 0.684). Conclusions: Oblique fracture pattern and Pucker sign may be associated with immediately postoperative rotational malreduction in the axial plane. Although patients with immediately postoperative rotational malreduction showed favorable results of long-term clinical outcomes, they required more weeks to recover the full range of elbow motion.

Finite element analysis of modified Slongo's external fixation in the treatment of supracondylar humeral fractures in older children.

Older children over 8 years old are at higher risk of elbow joint stiffness after treatment of supracondylar humeral fractures. The objective of this study was to improve the Slongo's external fixation system for treating supracondylar humeral fractures in older children. This would be achieved by increasing fixation strength and providing a theoretical basis through finite element analysis and mechanical testing. A 13-year-old female patient with a history of previous fracture was selected for CT data processing to create a three-dimensional model of the distal humerus fracture. Two internal fixation models were established, using the Slongo's external fixation method with Kirschner wire (Group A) and modifying the Slongo's external fixation (Kirschner wire tail fixation) (Group B). The fracture models were then subjected to mechanical loading analysis using Finite Element Analysis Abaqus 6.14 software to simulate separation, internal rotation, and torsion loads. A PVC humeral bone model was used to create a supracondylar fracture model, and the A and B internal fixation methods were applied separately. The anterior-posterior and torsional stresses were measured using the Bose Electroforce3510 testing system, followed by a comparative analysis. The finite element simulation results showed that under the same tensile, torsion, and inversion forces, the osteotomy model fixed with Kirschner wire at the distal end in Group B exhibited smaller tensile stress and deformation compared to the unfixed osteotomy model in Group A. This indicated that the fixation strength of Group B was superior to that of Group A. According to the test results of the Bose Electroforce3510 testing system, a simple linear regression analysis was conducted using SPSS software. The K values of rotation angle-torque tests and front and rear displacement-stress tests were calculated for Groups A and B, with Group B showing higher values than Group A. The results of this study supported the significantly enhanced biomechanical reliability and stability of fracture fixation in Group B, which utilized the modified Slongo's external fixation (Kirschner wire tail fixation). This optimized method provides a new choice for the clinical treatment of supracondylar humeral fractures in older children, backed by both clinical evidence and theoretical basis.