Fractures Of Humerus In Children Research Articles

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children.

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.

Complications and Predictors of Need for Return to the Operating Room in the Treatment of Supracondylar Humerus Fractures in Children.

Supracondylar humerus fractures are common pediatric injuries. Little is known about the risk factors for repeat operative procedures. A retrospective chart review of 709 patients treated for a displaced supracondylar humerus fracture was performed to identify risk factors for return to the operating room during the initial post-operative period. Deviations of routine fracture care were recorded and complication rates were compared between Gartland type 2 and 3 fractures using logistic regression. Type 3 fractures were found to have a higher complication rate, and, specifically, more peri-operative nerve palsies, more likely to need to return to the operating room for hardware removal, to lose fracture reduction, and require a return to the operating room for any reason. Five risk factors which may require returning to the operating room were identified: younger patient age, left sided fractures, type 3 fractures, peri-operative nerve palsy, and post-operative infection. In conclusion, Gartland type 3 supracondylar humerus fractures are associated with more complications then type 2 fractures. Risk factors for the need to return to the operating room in the post-operative period include: younger patient age, left sided fractures, type 3 fractures, peri-operative nerve palsy, and post-operative infection. Patients with these risk factors should be considered at risk for return to the OR and fracture fixation and follow up protocols should be adjusted for this risk.Level of Evidence : Prognostic Study, Level II.

Open reduction and Kirschner wire fixation for treatment of humeral lateral condylar fractures in children

Objective To investigate the early diagnosis and treatment strategies of lateral condylar fractures of humerus in children.Methods From July 2010 to July 2012,15 patients with humeral lateral condyle fractures were treated with open reduction and internal fixation with Kirschner wires in our hospital.The treatment outcomes were assessed using Flynn functional criteria and radiographical assessment of osteoarthritis or heterotopic ossification around the elbow.Results All the patients were follow-up for a mean time of 18.5 months (range,13 to 27 months).Bony healing was achieved in all the patients,within an average of 2.0 months (range,1.4 to 2.7 months).No nonunion and delayed union were observed in X-ray films.According to Flynn criteria,the results were excellent in 13 cases and good in 2 cases.Conclusion Displaced humerus lateral condyle fracture is easy to be misdiagnosed or missed because ossification occurs late in children.The fracture therefore doesn't show on X-rays.Early diagnosis is important in order to reduce various deformities and complications.Open reduction and crossed Kirschner wire fixation can lead to satisfactory reduction and firm fixation with fewer complications.At present it is an ideal method for treatment of lateral condylar fracture of humerus in children. Key words: Child; Humerus fractures; Early diagnosis; Lateral condyle

Epidemiological Study of Paediatric Supracondylar Humeral Fractures: Experience at a Tertiary Care Centre of North India.

Objectives: In this study we observed epidemiological pattern of paediatric supracondylar fractures presenting to a tertiary care centre of a developing country to work out factors that are preventable and need attention so as to decrease the morbidity of these difficult fractures. Methods: All the suspected cases of supracondylar fractures of humerus in children up to 15 years of age were evaluated for following parameters: 1. Age. 2. Sex. 3. Extremity involved (dominant or non-dominant). 4. Mode of trauma. 5. Time since injury. 6. Any history of intervention and type of intervention by local bone setter or healer. 7. Any compounding of fracture and if present classification as per Gustilo-Anderson grading. 8. Anatomical type of fracture (extension or flexion type). 9. Gartland type of fracture. 10. Associated injuries. 11. Complications at presentation. Data of 140 patients was tabulated and analysed using appropriate statistics. Conclusion: Near about one fifth of paediatric supracondylar fractures can be prevented by proper railing of roof tops and stairs. And morbidity reduced in developing nations by educating people about dangers of treatment by local bone setters. Community health workers have a pivotal role in this setting. Moreover, children with supracondylar fractures should always be screened for injury to ipsilateral forearm bones.

Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach.

This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn's criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar. Type 3 supracondylar fracture humerus, medial approach, crossed K-wire fixation, medial column comminution.

Operative Treatment of Type II Supracondylar Humerus Fractures

Because of the changing referral patterns, operative pediatric supracondylar humerus fractures are increasingly being treated at tertiary referral centers. To expedite patient flow, type II fractures are sometimes pinned in a delayed manner. We sought to determine if delay in surgical treatment of modified Gartland type II supracondylar humerus fractures would affect the rate of complications following closed reduction and percutaneous pinning. We performed a retrospective review of a consecutive series of 399 modified Gartland type II supracondylar fractures treated operatively at a tertiary referral center over 4 years. Mean patient age in the type II group was 5 years (range, 1 to 15 y). A total of 48% were pinned within 24 hours, 52% pinned >24 hours after the injury. No difference was in detected in rates of major complications between the early and delayed treatment group. Four percent of patients sustained a complication (16 patients). There were no compartment syndromes, vascular injuries, or permanent nerve injuries. Complications included nerve injury (3), physical therapy referral for stiffness (3), pin site infection (2 treated with oral antibiotics, 4 treated with debridement), refracture (2), and loss of fixation or broken hardware (2). Of the 3 patients who sustained nerve injuries, all underwent surgery within 24 hours of injury. One patient developed an ulnar motor and sensory nerve palsy after fixation with crossed K-wires. This resolved by 7 weeks postoperatively. Two patients presented with an anterior interosseous nerve palsy-1 resolved 1 week after surgery, the other by 8 weeks postoperatively. Delay in surgery did not result in an increased rate of major complications following closed reduction and percutaneous pinning of type II supracondylar humerus fractures in children. Further prospective work is necessary to determine if there are subtle treatment benefits from emergent treatment of type II supracondylar humerus fractures. Level III-retrospective comparative series.

Treatment of Gartland Type III Pediatric Supracondylar Humerus Fractures With the Kapandji Technique in the Prone Position

The purpose of this study was to report the efficacy of the Kapandji technique performed in the prone position for humeral supracondylar fractures in children. Retrospective. Level I trauma center. We retrospectively reviewed 34 children with Gartland type III supracondylar humerus fractures. There were 22 boys and 12 girls with a mean age of 5.2 years (range, 1-12.7 years). Closed reduction and the Kapandji technique were performed in the prone position for all patients. The mean follow-up was 17.4 months (range, 13.2-24.8 months). We assessed preoperative and postoperative radiographs to evaluate the quality of the reduction. The clinical outcome was assessed according to the criteria of Flynn. All operations were performed in a closed manner, no cases required open reduction. Loss of reduction after K-wire fixation was identified in 2 patients. There were no pin-related nerve injuries. The mean range of elbow motion was 139.6 degrees. The clinical outcome was excellent in 31 patients, good in 2 patients (97% excellent or good), and fair in 1 patient. This technique is an effective and safe option to treat type III supracondylar humerus fractures in children. In patients with severe soft tissue swelling, unstable fracture reduction, or unable to achieve acceptable reduction, this technique could facilitate fracture reduction and avoid unnecessary open reduction. The disadvantage of this technique is that the prone position is less desirable for airway management. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of upper-extremity function following surgical treatment of displaced proximal humerus fractures in children

This study aims to assess the functional outcome of children treated with elastic stable intramedullary nailing (ESIN) for displaced proximal humerus fractures using the short version of the disabilities of the arm, shoulder, and hand outcome questionnaire (Quick DASH). Fifty-eight consecutive children with displaced proximal humerus fractures were treated with ESIN. Fifty-two children (89.7%) were available for follow-up and responded to the questionnaire after hardware removal. Average age at time of injury was 11.1 ± 2.8 years (range, 4-15.9). Among the 52 patients available for evaluation, 37 had a Quick DASH score of 0 (71.1%), seven a score of 2.3 (13.5%), four a score of 4.5 (7.7%), and four a score of 6.5 (7.7%). Shoulder and elbow ranges of motion were comparable with the noninjured side. No skin irritation or local infections were observed. There was no radiographic evidence of delayed union, refracture, hardware migration, or secondary displacement. Mean follow-up was 18.3 ± 8.3 months (range, 6-39.5). Our study reports good functional outcomes in children with closed isolated fractures, both physeal and metaphyseal, of the proximal humerus treated with ESIN. The use of a standardized rating scale is recommended to homogeneously compare functional outcome and may facilitate the comparison of clinical outcome in different patient populations.

The displaced supracondylar humerus fracture

Supracondylar humerus fractures are the most common elbow fractures in children. Choice of treatment may be guided by the Gartland classification. Recent studies recommend conservative management for non or minimally displaced fractures, whereas there seems to be a trend towards surgical intervention for all displaced fractures. The purpose of this review is to discuss the various treatment options for displaced supracondylar humerus fractures. Closed reduction and percutaneous pinning are the preferred treatment options for most displaced pediatric supracondylar fractures of the humerus. The ideal pin configuration has always been subject to great controversy. It is well known that placement of a medial pin carries the risk of iatrogenic ulnar nerve injury, whereas lateral pinning carries an increased risk of median neuropathy. Therefore, given the potential risk, it is recommended to avoid medial pinning to prevent damage to the ulnar nerve and stabilize the fracture with two or three lateral pins. Today, the preferred treatment of displaced supracondylar humerus fractures in children is immediate closed reduction and percutaneous fixation with two or three lateral pins. In case of instability of the medial column, a medial pin may be used, but possibility of iatrogenic ulnar nerve injury should be considered.

Orthopedic versus surgical treatment of Gartland type II supracondylar humerus fracture in children

The choice of orthopedic or surgical treatment for Gartland type II supracondylar humeral fractures remains controversial. The aim of this study was to retrospectively compare the outcomes in orthopedic and surgical treatment in type II supracondylar humeral fractures in children treated in the Orthopedic and Traumatology Children Unit of our tertiary hospital over the period between 2007 and 2010. This study suggests that orthopedic treatment is a valid option for the treatment of this type of fractures, with radiological and functional results as good as those obtained with surgical treatment, avoiding surgical complications and decreasing the hospital stay.

Close Reduction and Percutaneous K-wire Fixation without Image Intensifier in Supracondylar Fracture of Humerus in Children

Introduction: Extension Type III supracondyla fractures of the humerus is most common fractures around the elbow in children. Closed reduction and percutaneous pinning under image intensifier guide has been the gold standard method of treatment. However, image intensifier is not readily available in most part of our country. Closed reduction and percutaneous pinning is possible even without image intensifier. we report our case series of 51 cases who underwent closed reduction and percutaneous pinning without image intensifier. Methods: Between November 2009 and April 2011 a total of 51 children with a displaced supracondylar fractures of the humerus were managed by close reduction and percuteneus k-wire fixation without using image intensifier. They were followed for a period of minimum 6 months up to one and a half years (average one year) and the final outcome was assessed using functional and cosmetic criteria used by Flynn and associates. Results: Of these 51 patients, 46 (90%) patients showed an excellent results. Satisfactory results were achieved in 4 (8%) patients, poor in 1(2%) patients. Conclusion: Close reduction and percutaneous K-wire fixation without using image intensifier is radiation free, cost effective and relatively safe method of management of displaced supracondylar fractures of humerus in children. It can be used in a remote hospital where the facilities of image intensifier or portable x-ray are not available. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9321 Nepal Orthopedic Association Journal 2013 Vol.3(1): 19-22

DISPLACED SUPRACONDYLAR HUMERAL FRACTURES;

Objective: To compare outcome of patients with supracondylar fractures of humerus treated by cross k wires and lateralentry k wires in children. Study Design: Randomized controlled trial study. Place and duration of study: January 2012 to December2012 at Department of Orthopedics, Nawaz Sharif Social Security hospital, Lahore. Subjects and Methods: Two hundred patients,meeting the selection criteria were identified. These patients were divided into group A and group B randomly. In group A cross k wirefixation and in group B lateral entry k wire fixation was performed. Loss of reduction was assessed and recorded in the immediatepostoperative period and three weeks later at the time of removal of k wires. Range of motion of the elbow, in the form of excellent outcomewas assessed at the end of 12 weeks postoperatively. Results: A total of 200 patients were included in the study. Loss of reduction wasfound in thirty patients (30%) in group A and in forty one patients (41%) in group B. In group A, seventy two patients (72%) had excellentoutcome while twenty eight patients (28%) did not gain the desired range of motion at elbow. In group B, sixty five patients (65%) hadexcellent outcome while in thirty five patients (35%), the desired range of motion at elbow was not achieved. No neurological injuryoccurred with both configurations. Conclusions: Lateral entry k wire fixation is as effective as cross k wire in the treatment of displacedsupracondyler fracture of humerus in children.

Management of Pediatric Type III Supracondylar Humerus Fractures in the United States

Supracondylar humerus fractures are common injuries in the pediatric population. The most severe, type III injuries, have seen the most debate on treatment regimens. Traditionally, these fractures were treated as surgical emergencies, most often fixed with percutaneous pinning in a cross-pin configuration. The recent literature shows that delayed fixation is comparable to emergent fixation as long as there is no vascular compromise with the injury. A short survey was sent to Pediatric Orthopaedic Society of North America (POSNA) members using an online survey and questionnaire service. The purpose of the survey was to establish an overview of current practices in the United States concerning treatment of type III supracondylar humerus fractures and the influence of the recent literature on the management of these injuries. A total of 309 members, representing a wide range of locations and years in practice, responded to our survey. About 81% preferred to splint type III supracondylar humerus fractures and plan for fixation the following morning, assuming there was no issue necessitating emergent fixation. The preferred method of percutaneous fixation was fairly evenly distributed between cross-pin configuration (30%), 2 lateral pins (33%), and 3 lateral pins (37%). About 56% of those surveyed stated that the recent literature showing comparable outcomes with 2 lateral pins versus a cross-pin configuration had not changed their approaches to management of these fractures concerning the method of fixation. The trend in management of type III supracondylar humerus fractures in children is progressing toward delayed treatment and lateral pin configuration. The results provide an overview of the current practice of POSNA members concerning management of these fractures. We believe this information is beneficial to both pediatric-trained and nonpediatric-trained orthopaedic surgeons to help guide their decisions when dealing with these injuries. This study is a Level V Therapeutic Study reviewing trends in the management of type III supracondylar humerus fractures in children. The previously described experts represent various levels of expertise in their preferred method of fixation.

Evaluation on efficacy of three surgery approaches for the treatment of supracondylar fracture of humerus in children

Objective To evaluate the efficacy of three surgery approaches for the treatment of supracondylar fractures of humerus in children.Methods 77 children with supracondylar fractures of humerus were randomized into 3 groups after diagnosis.Children in Group A underwent posterior tricep splitting approach,Group B underwent lingulate flap of tricep brachii approach,and Group C underwent bilateral tricep brachii approach.The surgical results of all cases were analyzed and compared.Results The incision closure time and duration of surgery of Group C were shorter than those of Group A and B (P ＜ 0.05 and P ＜ 0.01 respectively).The excellent and good rate of elbow function evaluation in Group C was higher than those in Group A and B (P ＜ 0.05).All the differences were statistically significant.Conclusion Bilateral tricep brachii approach is an effective approach for treatment of supracondylar fracture of humerus in children. Key words: Children; Supracondylar fractures of humerus; Operative approach

Limited open reduction versus closed reduction in treatment of supracondylar humerus fractures in children

Objective To compare the clinical effects of limited open reduction versus closed reduction in treatment of supracondylar humerus fractures (Gartland type Ⅲ) in children.Methods The clinical data of 98 children who had been treated for supracondylar humerus fractures (Gartland type Ⅲ) in our department from January 2008 to December 2010 were available for the present retrospective analysis.Eighty-seven patients were treated with open reduction via a limited medial or lateral incision followed by internal fixation while the other 20 with closed reduction followed by internal fixation.In the limited open reduction group,there were 53 boys and 25 girls,with a mean age of 76.4 months; in the closed reduction group,there were 15 boys and 5 girls,with a mean age of 70.7 months.The 2 groups were compared in terms of operative time,intraoperative radiography frequency,fracture healing,Flynn elbow scoring at 3 and 12 months postoperation.Results Compared with the closed reduction group,the limited open reduction group needed significantly shorter average operative time (52.2-7.0 minutes versus 72.8 ± 13.7 minutes) and significantly lower average intraoperative radiography frequency (3.3 ± 1.0 times versus 9.9 ± 1.9times) (P ＜ 0.05).The 98 patients received a mean follow-up of 16.3 months (from 12 to 24 months).All the fractures achieved clinical healing at 4 weeks post-operation and bony union at 2 months post-operation.By the Flynn elbow scoring at 3 months postoperation,the good to excellent rate was 24.4 ％ (19/78) in the limited open reduction group and 30.0％ (6/20) in the closed reduction group,with no significant difference (P ＞ 0.05).However,the good to excellent rate at 12 months post-operation was 100％ (78/78) in the limited open reduction group and 95.0％ (19/20) in the closed reduction group,with a significant difference (P ＜ 0.05).No delayed union,compartment syndrome or iatrogenic lesions to vessels and nerves occurred and no supracondylar osteotomy was needed in either group.Conclusions In treatment of supracondylar humerus fractures (Gartland type Ⅲ) in children,both limited open reduction and closed reduction can lead to fracture healing in similar time and similar functional recovery of the elbow.It is essential to perform limited open reduction when closed reduction fails.Limited open reduction can result in shorter operative time,lower intraoperative radiography frequency and better functional outcomes. Key words: Elbow joint; Humeral fractures; Fracture fixation, internal; Child

An evaluation of supracondylar humerus fractures: Is there a correlation between postponing treatment and the need for open surgical intervention?

The goal of this study was to evaluate the treatment and recovery of patients treated for Gartland type III supracondylar humerus fractures in order to determine if postponing treatment leads to a higher rate of open surgical treatment or complications. A retrospective study was conducted examining the medical records of children with Gartland type III supracondylar humerus fractures at our institution for a two-year period. The patients included in the study were treated with closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). After exclusions, 134 patients were included in the study, with an average age of 5.6years. The patients were grouped according to whether their treatment was postponed (39.6%) or immediate (60.4%). The majority of all patients were treated using CRPP: 46 (86.8%) of the postponed patients and 75 (92.6%) of the immediate patients. Very few postsurgical complications occurred in the patients; there was only one (1.6%) case of iatrogenic nerve injury in a postponed patient as well as four (3.8%) cases of loss of carrying angle: one (2.3%) in postponed patients and three (4.8%) in immediate patients. Postponing treatment of type III supracondylar humerus fractures in children did not lead to an increase in open surgical treatment; nor did it lead to an increase in complications.

Ultraschallbasierte Therapiesteuerung bei subkapitalen Humerusfrakturen im Wachstumsalter

The treatment of juvenile proximal humerus fractures is based on the extent of the deformity. The standard diagnosis with X-ray images in 2 directions is error-prone and can lead to a suboptimal treatment. The aim of this study was to evaluate if ultrasound imaging can improve the measurement of the deformity of proximal humerus fractures. In a prospective, multicentre trial children aged 0-12 years with a suspected proximal humerus fracture were initially examined with a 10-MHz linear transducer in 4 directions and the maximum deformity was determined. Afterwards the standard X-rays were taken and the results of both methods compared. The certainty of both methods was compared with a standardised nominal scale. From 8/2010 to 5/2011 6 consultants in 4 hospitals examined 30 patients (16 m, 14 f, mean age 7.9 years). In 15 cases the ultrasound showed a larger deformation than the X-rays and in 2 cases vice versa. In 11 cases the measurement was identical 6 of which were undisplaced. The mean difference of the measurement of the deformity was + 8.6°, with 14.2° in the displaced fractures. The certainty of the ultrasound was rated significantly higher (p < 0.05) than that of radiography. With a correct technique the deformity cannot be overestimated by ultrasound means and the safeness is rated significantly higher in comparison to the X-ray imaging. It seems that ultrasound is a meaningful method to improve the measurement of the deformity of proximal humerus fractures in children. Deficiencies are found only in cases with massive deformities which demand a reduction and stabilisation.

Functional results of displaced proximal humerus fractures in children treated by elastic stable intramedullary nail

Displaced proximal humerus fractures within the pediatric population can be treated by elastic stable intramedullary nailing (ESIN). The main objective of our study is to evaluate functional outcome of the displaced proximal humeral fractures treated by ESIN within the pediatric group using a standardized evaluation scale. The secondary goal is to compare functional outcome of epiphyseal and metaphyseal injuries and functional outcome of children younger and older than 10 years of age. From March 2010 to December 2011, 27 children had been treated surgically using ESIN for displaced fractures at the proximal extremity of the humerus. These fractures were displaced and closed without neurovascular insult. Patients were followed radiographically and clinically on a regular basis. After hardware removal, the functional outcomes had been homogeneously assessed by using the French edition of the QuickDash(®) evaluation scale. The descriptive statistics including mean, standard deviation, and confidence interval have been realized. We included 27 children who were operated on consecutively (10 boys, 17 girls). The mean age at the time of operation is 11.2 ± 2.7 years (range 7.1-15.9). The mean angulation is 55.9° ± 20.3° (range 20-90). The mean apposition is 52.8 % ± 33.1 (range 10-100). The mean follow-up period is 15.2 ± 5.6 months (range 6.1-28.5). Results were considered good for children between 7.1 and 15.9 years old with epiphyseal and meataphyseal fractures. The mean QuickDash(®) score is 2.0 (range 0-6.5), with 14 cases showing a score of 0 (58.3 %), 2 cases with 4.3 (8.3 %), 4 cases with 4.5 (16.7 %), and 4 cases with a score of 6.5 (16.7 %). Ranges of movement were preserved. The patients regained their daily and sportive activity over the time without pain or discomfort. Our study showed a good outcome of functional results within a pediatric population who had a sustained displaced proximal humeral fracture and treated by ESIN. Using a standardized evaluation scale is recommended in order to be able to evaluate the patients in a homogeneous manner.

Percutaneous lateral Kirschner wire fixation in pediatric supracondylar fractures of humerus

Aim: This prospective study was conducted to know the outcome of percutaneous lateral pinning in the management of displaced supracondylar fracture of humerus in children. Settings and Designs: Prospective study. Materials and Methods: Eighty five patients with displaced supracondylar fractures admitted between July 2005 and July 2010 were recruited into the study. All patients were operated under general anesthesia within 24 h after trauma using the percutaneous 2-lateral pin fixation (n = 85). Results were analyzed using Flynn's criteria. All patients were followed up to 6 months post-operatively. Results: Eighty five displaced supracondylar fractures of humerus, aged between 1½ year and 13 years, were treated using close reduction and percutaneous Kirschner (K) wire fixation under the c-arm image intensifier. Above elbow plaster of paris back slab was applied in all cases for at least 4 weeks. The slab and K-wires were removed after 4 weeks and elbow range of motion exercise was started. 68.23% had excellent, 29.40% good, 1.17% fair and 1.17% had poor results at 8 th weeks, which was improved to 91.75% excellent, 7.05% good, 1.17% fair and no poor result at final follow-up. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. Five patients developed superficial pin tract infection post-operatively and were treated conservatively with good healing and no long-term sequelae. Conclusion: Closed reduction and percutaneous lateral pinning proved an efficient, reliable, and safe method in the treatment of displaced supracondylar fractures of the humerus in children.

Percutaneous K-wire fixation in paediatric Supracondylar fractures of humerus: A retrospective study

Background:Supracondylar fractures are the commonest elbow injury in children. Most displaced Supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. It was the purpose of this study to investigate the treatment of this injury in this unique patient population.Materials and Methods:This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010. One hundred seventy patients were recruited from Emergency and outpatient department having closed displaced Supracondylar fractures of humerus in children. They were treated either with medial-lateral pin fixation (n = 85) or with 2-lateral pin fixation (n = 85). All patients were operated under general anaesthesia. All patients were followed for 6 months. Results were analysed using Flynn's criteria.Statistical Analysis Used:Chi Square Test. Chi Square calculator was used as a software.Results:All children achieved union in a mean time of 4 weeks (range: 3-6 weeks). Post-operatively, eight patients (4.70%) got ulnar nerve injury and six (3.52%) patients got pin tract infection. Comparison between two groups such as cross K-wire group (85) and lateral K-wire group (n = 85) by using the Chi Square Test showed that in case of 8 weeks with (P-values = 0.89), in 16 weeks (P = 0.91) and 24 weeks (P = 0.85) with respective excellent, good, fair and poor categories were not found statistically significant.Conclusion:The lateral percutaneous pinning technique of displaced Supracondylar fractures of the humerus offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.