Humerus In Children Research Articles

A systematic review and meta-analysis of adverse outcomes following non-buried versus buried Kirschner wires for paediatric lateral condyle elbow fractures.

PurposeFractures of the lateral condyle of the humerus in children are a common injury. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). K-wires are placed using either an open or closed technique. The decision to bury or leave the ends extending through the skin is surgeon-dependent and based on factors including post-operative infection risk, bony union and ease of wire removal.MethodsWe performed a systematic review and meta-analysis of non-buried versus buried K-wires for lateral condyle elbow fractures in children in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A comprehensive search strategy included Medline, Embase and CINAHL via NICE Evidence from database inception to June 2017. Two authors independently reviewed, included or excluded articles, extracted data and assessed for quality with the ROBINS-I tool. We performed direct comparison meta-analysis for all adverse events, post-operative infection and failure of bony union.ResultsThree studies were analysed comprising of 434 participants. There was a significantly reduced relative risk of adverse events in the non-buried group, equating to approximately 45% reduced risk (RR 0.55, 95% confidence interval 0.34 to 0.88). There were no significant differences in risk of post-operative infection or failure of bony union. All three cost-analyses in the included studies observed savings with non-buried K-wires.ConclusionNon-buried K-wires for lateral condyle elbow fractures convey a lower risk of adverse events and may be more cost-effective compared with buried K-wires. Non-buried K-wires do not appear to increase the risk of infection or failure of bony union. These findings are limited by a high risk of bias due to inherent methodological flaws in the design of included studies.

Fijación percutánea del alambre K en las fracturas condilares laterales pediátricas del húmero: un estudio prospectivo

BackgroundWe evaluated the radiographic and clinical functional results of K-wire fixation in the treatment of displaced lateral condyle fractures of the humerus. Materials and methodsA prospective longitudinal study was undertaken in our hospital during the period December 2010-December 2014. A total number of 85 children (18 girls and 67 boys) mean age 7.76 years; range 2-13 years with displaced (>2mm) lateral condyle fractures of the humerus. All the patients were treated by close reduction and internal fixation with two K-wires for three weeks. The fractures were classified according to the criteria by Milch and Badelon and functional results were evaluated according to the criteria by Hardacre et al. The mean follow-up period was 24 months (range: 20-28 months). ResultsAll children achieved union in a mean time of 3 weeks (range: 2.5-6 weeks). Functional results were excellent in 91.75% children and good in 7.05% children. Full range of elbow motion was achieved in all the patients. None of the patients had instability postoperatively. Post-operatively, 5.88% children got pin tract infection, which was superficial and healed after removing pins and oral antibiotic administration. ConclusionPercutaneous K-wire fixation is an effective treatment for unstable displaced lateral condylar fractures of the humerus in children. If fracture displacement after closed reduction exceeds 2mm, open reduction and internal fixation is recommended.

Outcome of early versus delayed Kirschner wire fixation of supracondylar fractures of humerus in children

Purpose: Controversy still persists regarding optimum intervention time for late presentations of supracondylar fracture of humerus in children. We compared outcomes in early and late groups of presentation and management. Study design: We conducted prospective study comparing early and late open reduction and Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 16 years. We analyzed results of 27 cases in early group and 19(8 lost) cases in late group. We compared duration of surgery, range of motion, and Flynn’s criteria were used to evaluate outcome. Results: Thirty (65%) patients were male and 15(32.60%) had dominant limb involvement. Injury to surgery time was 53.63±41.03 hours in early group and 338.53±134.31 hours in late group (p

Late presenting lateral condyle fracture of the humerus in children - clinical outcome of surgical fixation

Aim: To assess the surgical outcome of Late presenting lateral condyle fracture of the humerus in children with open reduction k-wire/cancellous screw fixation. Material and Methods: After obtaining approval of the ethics committee, a prospective study was conducted in the department of orthopedics Navodaya Medical College and research center, Raichur from March 2015 to August 2016. 13 cases of Late presenting lateral condyle fracture of the humerus in children underwent surgery with k-wire/cancellous screw fixation. We evaluated scoring system proposed by Dhillon et al. to determine the outcomes. Results: There were 9 males and 4 females with a mean age of 7 years and 3 months (range 4-13 years). The average time interval between injury and internal fixation was 4.1 weeks. (Range 3 weeks to 7 weeks). In our study 5 patients got Excellent; 6 patients Good; 2 patients Fair; and 1 patient got Poor results. We encountered major complication in 1 patient who devolved AVN lateral condyle of humerus. Minor complications were noted in total 5 patients. Pin tract infection was the most common in 3 patients and one patient had residual flexion deformity of 15 degree with ROM of 110 degree and another patient had stiffness of elbow. Conclusion: We conclude from our study that late presenting fracture of lateral condyle of humerus needs surgical intervention which can be reasonably reduced and union achieved obtaining satisfactory functional outcome.

Comparative study of closed reduction vs. open reduction fixed with k-wiring in type 3 displaced supracondylar fractures in children

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Among all the fractures in upper limb in children, supracondylar fractures of the humerus are more common injuries. In general the fractures of children are treated conservatively. But the management of supracondylar fractures has evolved over years from conservative to more aggressive approach operative techniques.</span></p><p class="abstract"><strong>Methods:</strong> The study was conducted in children's presenting with type 3 Gartland supracondylar fractures to Adichunchanagiri Institute of Medical Sciences, B. G. Nagara between January 2014 to December 2016.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The study consisted of 40 type 3 supracondylar fractures cases. Group A (closed reduction) had 25 cases, among them were 20 males and 5 were females. Group B (open reduction) had 15 cases among them 12 males and 3 female cases. The patients were between the age of 6 to12 years. In Group A, 19 children were in the age group of 6-10 years where as Group B had 12 cases. In Group A, 6 were in the age group of 10-12 years and 3 cases in Group B. Among the 25 cases in Group A, 19 were left sided and 6 were right sided. In group B, 11 were left sided and 4 were right sided. All patients had achieved clinical and radiological union at 4 weeks. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Closed reduction and k-wiring had very good results for type 3 supracondylar fractures of humerus in children than conservative/open reduction methods. However for cases which we didn't get proper/satisfactory reduction in closed method, open method with triceps splitting approach was used.</span></p>

Management of completely displaced extention type supracondylar fractures of humerus in children based on a new classification

BackgroundPaediatric supracondylar fractures are the most common childhood fractures under 8 years of age. Displaced paediatric supracondylar fractures are mostly classified on the basis of fracture geometry and none of the classification systems takes the clinical condition of the limb into consideration. ObjectiveThe purpose of this study was to evaluate the functional outcome of displaced extention type supracondylar fractures of humerus in children managed on the basis of our new classification. Material and methodsA total of 207 children with displaced extention type supracondylar fractures of humerus were classified as per our classification system into simple and complex types, They were managed and followed over a mean period of 24 weeks, and the results were recorded at the final follow-up. ResultsWe had 175 simple and 32 complex fractures. There was a significant difference in mean surgical time between simple (19.64±3.52min) and complex fractures (43.41±27.07min). Mean duration of hospital stay was significantly lower in simple fractures (1.02±0.31days) as compared to complex fractures (2.62±1.84days). Out of 175 patients in simple group 167 (95.4%) had excellent result,6 (3.4%) had good result 1 (0.6%) had fair result and 1 (0.6%) had poor result whereas out of 32 patients in complex group 10 (31.3%) had excellent result, 5 (15.6%) had good result, 11 (34.4%) had fair result and 6 (18.8) had poor result. Overall results were better in simple group as compared to complex group as per Flynn criteria. ConclusionsManagement of patients with displaced supracondylar fractures of humerus using Barza classification in emergency room gives good result and gives an idea about management and prognosis.

Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe?

Blount's method is controversial for the treatment of Gartland types IIB and III supracondylar fracture of the humerus (SCFH) in children. The purpose of this study was to evaluate the clinical and radiologic outcomes and the failure and complication rates. All types IIB and III SCFH treated with Blount's method from 2003-2013 were included in this retrospective single-center study. Clinical assessment was performed according to Flynn criteria. Baumann angle, anteversion angle, anterior humeral line, and humeroulnar angle were measured for radiographic assessment. Among 447 children with types IIB and III SCHF, 339 were treated according to Blount's method. There were 173 boys (51%), and the mean age was 6.3 years (1-14 years); 71% were type III. Mean time to surgery was 5.7 hours. According to Flynn criteria, results were satisfactory in 91% of cases. No compartment syndrome was encountered. There were 16 (4.7%) secondary displacements requiring surgical revision. Five (1.9%) children developed a cubitus varus deformity. At latest follow-up, the mean Baumann angle was 74.7° (95% confidence interval, 74.1-75.3), the mean anteversion angle was 39.9° (95% confidence interval, 39.5-40.3), the anterior humeral line was normal in 87.6% of cases, and the mean humeroulnar angle was 8.7°. Blount's method is appropriate to manage types IIB and III SCFH, provided anatomic and stable reduction is obtained.

CORR Insights®: Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

CORR Insights®: Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

Interventions for treating supracondylar fractures of the humerus in children

Reason for withdrawal from publication This out-of-date protocol was withdrawn from publication, as of Issue 7, 2017, due to a lack of progress on the review.

Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

There are several options for reconstruction of proximal humerus resections after wide resection for malignant tumors in children. The clavicula pro humero technique is a biologic option that has been used in the past, but there are only scant case reports and small series that comment on the results of the procedure. Because the longevity of children mandates a reconstruction with potential longevity not likely to be achieved by other techniques, the clavicula pro humero technique may be a potential option in selected patients. (1) How successful is the clavicula pro humero procedure in achieving local tumor control? (2) What is the frequency of nonunion? (3) What are the complications of the procedure? (4) What scores do patients achieve (on the Musculoskeletal Tumor Society (MSTS) and the Toronto Extremity Salvage Score (TESS) after this procedure? Four university hospitals performed the clavicula pro humero technique in eight children aged 8 to 18 years between June 2006 and February 2014. During that period, general indications for this approach included all reconstructions of the proximal humerus for malignant tumors in children older than 8 years. All patients were followed for a mean of 40 months (range, 25-86 months); one patient was lost to followup before 2 years. The tumor resections removed the rotator cuff muscles in all patients, glenohumeral joint in five, and deltoid muscle in three. The median length of the bone defect after resection was 20 cm (range, 7-25 cm). It was reduced to 9 cm (range, 0-17 cm) or 27% (range, 0%-64%) of the total humerus length after clavicular rotation. Direct osteosynthesis (one patient), induced membrane technique (one patient), or vascularized fibular autograft (six patients) was used to complete the defect after rotation of the clavicle if necessary. Presence of union (defined as bone healing before 10months, as assessed by disappearance of the osteotomy on AP and lateral view radiographs), and complications were determined by chart review performed by a surgeon not involved in patient care. Function assessed by the MSTS and the TESS scores were determined by the patients with their families. None of the patients had tumor recurrence. One patient died of pulmonary metastases before the 2-year followup. Proximal and distal bone unions were achieved before 10months without an additional surgical procedure in two and six of seven patients, respectively. Fourteen local complications occurred resulting in nine revision operations. The main complication was aseptic proximal pseudarthrosis (five patients); other complications included one proximal junction fracture, one clavicle fracture complicated by clavicle osteolysis, one distal junction fracture, one necrosis of the skin paddle of the fibular autograft, one glenoclavicular ossification, and one distal pseudarthrosis complicated by a fracture of this distal junction. Function, as assessed by the MSTS score, was a median of 23 of 30 (range, 11-27). The median TESS score was 82% (range, 75%-92%). Shoulder ROM (median; range) in abduction, front elevation, and external and internal rotations were 70°(30°-90°), 75°(30°-85°), 10°(0°-20°), and 80°(80°-100°), respectively. Three of the seven patients reported dissatisfaction with the cosmetic appearance. The clavicula pro humero technique achieved oncologic local control after resection and reconstruction of proximal humerus tumors in children. Although union times are approximately 2years and some patients underwent augmentation with other grafts, it eventually provides a solid, painless, biologic, and stable reconstruction and creates a mobile acromioclavicular joint and generally good function. Nonunion of the proximal junction is the main complication of this technique. We cannot directly compare this technique with other reconstruction options, and longer followup is needed, but this may be a useful reconstruction option to consider in select pediatric patients with sarcomas of the proximal humerus. Level IV, therapeutic study.

SUPRACONDYLAR FRACTURE;

Objectives: is to compare the outcomes of open versus closed PercutaneousK wire fixation in displaced supracondy fracture of humerus in children. Period: May 2016 toMay 2017. Setting: Orthopedic unit of Nishtar Hospital Multan. Methodology: Total numberof 170 (100%) patients of displaced supracondylar fracture of humerus was enrolled. Patientswere divided into two equal groups by lottry method (85 patients in each group). SPSS version23 was used to analyze the data, mean and standard deviation was calculated for numericalvariables like age and flayn et al score, and frequencies with percentages were calculated forcategorical variables like gender and outcome variable satisfactory/unsatisfactory. Chi squaretest was applied to see the effect of effect modifiers on outcome variable. P value of ≤0.05was considered as significant. Results: Total of 170 (100%) divided in two equal groups Aand B, 85 patients in each group. Out of 170 patients 97 (57.1%) were male and 73 (42.9%)were female. Out of these in group A 75 (88.1%) patients have satisfactory outcome and 10(11.7%) patients have unsatisfactory outcome. Similarly in group B, 71 (83.5%) were havingsatisfactory and 14 (16.47%) have unsatisfactory outcome and P= 0.37. Conclusion: Results ofour study concluded that open reduction with K wire fixation technique have better satisfactoryoutcome (union rate) as compared to closed reduction and K wire fixation in the managementof supracondaylar fracture of humerus in young age group.

A prospective study of surgical management of the displaced supracondylar fractures of humerus in children with k wire fixation

Background: Supracondylar fractures of humerus is the commonest injury, constitutes about 65.4% of all fractures about the elbow in children. Displaced supracondylar fracture of humerus demand great respect and challenging one to treat, since it requires accurate anatomical reduction and internal fixation to prevent complications. So, in this study, we reported the results of closed and open reduction and internal fixation with K-wires in the displaced supracondylar fracture humerus in children. Material and Methods: Fourty cases of displaced (Gartland’s type 2 and 3) supracondylar fractures treated by internal fixation with K-wires were studied between September 2013 to August 2015 at our institution and followed for an average of 24 months. Results: We came across 26male patients and 14 female patients. Majority of the cases were due to high energy trauma of road traffic accidents involving relatively younger patients. At the end of 5 months, all except four patients could mobilize independently without any aid. We did not come across complications like fracture of femur and failure of fixation and no reoperations were required. Conclusions: Internal fixation with K-wires is the most commonly accepted treatment of displaced supracondylar fracture humerus in children when done at appropriate time. It gives more stable fixation, better anatomical reduction with negligible complication.

A prospective study of crossed versus lateral only pinning in the treatment of displaced supracondylar fractures of the humerus in children

Supracondylar fracture of humerus in children is the most common fracture of the upper limb. There is a lot of controversy regarding optimal method of treatment. Some others prefer lateral only pinning and others prefer crossed medio lateral pinning. We conducted a study at Mc Gann teaching district hospital Shivamogga to compare the results of lateral only pinning and crossed medio lateral pinning in supracondylar fracture humerus in children. There were 20 patients in each group. The results were assessed by as per criteria of Mitchell and Adams (1961) and Flynn’s criteria. There was no statistically significant difference in the outcome of both the groups when assessed by above criteria

Is outcome of delayed fixation is comparable with early fixation in type 3 supracondylar humerus fracture in children

Background: Gartland type 3 supracondylar fractures of the humerus in children have been associated with serious complications and believed to benefit from an emergency treatment. However, several unavoidable factors sometimes lead to surgical delays even in tertiary hospital. The present study was undertaken to assess the functional and radiological outcome with respect to the timing of intervention post injury. Methods: In the observational study, paediatric patients with type 3 supracondylar humerus fractures were divided in 2 groups based on the timing of treatment, within 12 hours or after 12 hours of injury. The data was collected in a retrospective and prospective manner with minimum 9 months of follow-up and the study variables such as age, type of displacement, requirement of open reduction, period of immobilization, time for fracture union, change in range of motion and carrying angle and incidence of complication was noted. Results: The baseline variables was comparable in both the groups. There was no significant need of an open reduction in patients in both the groups. Following limb immobilization for 3-4 weeks after closed reduction, all patients had successful fracture union. There was no significant difference in change in the carrying angle and range of movement in both the groups. The incidence of complications was comparable in both the groups. Conclusion: We recommend that the surgery can be safely postponed to next available operation theatre in non-complicated cases of severe supracondylar fracture humerus to facilitate finest pre-operative care and an optimal care surgery.

Outcome of surgically treated displaced medial epicondyle fracture of humerus in children: A prospective study

Conclusion: Anatomical reduction either close or open and percutaneous kirschner wires fixation affords a significantly higher union rate, a significantly higher functional outcome score and a significantly better range of movement of the elbow joint.

Implementation of A Protocol for Treatment of Supracondylar Fractures of Humerus in Children.

AIM: Supracondylar fractures of the humerus in children are very fearful lesions due to its diagnosis, treatment, associated lesions and the after-effects. Moreover, there are a broad number of treatments. In 2009 we implanted a protocol for the supracondylar fractures treatment. MATERIAL AND METHODS: Analysis of patients hospitalized with supracondylar fractures of the humerus between March 2009 and March 2011. In the study we analyzed the type of fracture according to Gartland’s classification, type of immobilization and reduction and the number and placing of the Kirschner wires. Independent observer analyzed the results. Non-displaced fractures were not included. RESULTS: A total of 45 patients were attended during that period. The mean age was 6,9 years old, 66% males and 66% with the left arm injured. Type of fracture: type II (14), type III (31). Three cases were treated with orthopedic management. In 4 cases, closed surgical treatment was not sufficient an open surgery was required. The others (38) were treated with closed surgery. Functional were 38 excellent/good and 7 regular/bad. Radiological result shows a horizontalization of Baumann’s angle related to the crossed pattern of the k-wires (p=0.043). Statistical study shows a relationship between the protocol’s follow-up and good results (p=0.039). CONCLUSION: Following the protocol guarantees an 84,4% less reinterventions and better clinical outcomes (p=0.039).The crossed pattern of the Kirschner wires presents a good stabilization of the fracture but decreases the Baumann’s angle (p=0.043), and thus increasing the radiological cubital varus although it has no clinical repercussion (p>0.05).

What is the best fixation technique for the treatment of supracondylar humerus fractures in children?

ObjectiveTo define the best technique for the surgical treatment of supracondylar fracture of the humerus (SFH) in children, evaluating percutaneous pinning with side wires vs. cross-pinning. MethodsRandomized controlled trials using the Medline, CAPES, and BIREME. The criteria for inclusion of articles criteria were: (1) randomized controlled trials (RCTs) comparing percutaneous wire fixation techniques, (2) SFH Gartland II B, III, and IV, and (3) children aged 1–14 years. The following were used as main variables: incidence of iatrogenic injury to the ulnar nerve and loss reduction. ResultsEight studies were selected (521 patients) comparing surgical treatment with pinning in supracondylar fracture of the humerus in children Gartland II type B, III or IV. Iatrogenic injury to the ulnar nerve was greater with the cross-pinning technique, with RR 0.28 and p=0.03, while the mini-open technique presented RR 0.14 and p=0.2. A statistically significant greater loss of reduction in the lateral pinning was observed in FSU Gartland III and IV(p=0.04). ConclusionBased upon this meta-analysis of prospective randomized clinical trials, the following is recommended: (1) percutaneous pinning with lateral wires in supracondylar fractures of the humerus in children classified as Gartland II type B; (2) use of crossed wires for Gartland type III or IV, using the mini-open technique for the medial wire.

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

AbstractSupracondylar humeral fractures (SCHF) are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I) is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III) of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4%) were boys and 17 (26.6%) were girls. The most common age range (59.4%) in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.Based on the results of the analysed parameters, consisting primarily of functional results, the absence of subjective symptoms and myositis ossificans one year after surgery suggests that emergency surgical treatment of displaced supracondylar humeral fractures is optimal.

Qual a melhor técnica para fixação no tratamento de fratura supracondilar do úmero em crianças?

ObjectiveTo define the best technique for the surgical treatment of supracondylar fracture of the humerus (SFH) in children, evaluating percutaneous pinning with side wires vs. cross‐pinning. MethodsRandomized controlled trials using the Medline, CAPES, and BIREME. The criteria for inclusion of articles criteria were: (1) randomized controlled trials (RCTs) comparing percutaneous wire fixation techniques, (2) SFH Gartland II B, III, and IV, and (3) children aged 1 to 14 years. The following were used as main variables: incidence of iatrogenic injury to the ulnar nerve and loss of reduction. ResultsEight studies were selected (521 patients) comparing surgical treatment with pinning in supracondylar fracture of the humerus in children Gartland II type B, III or IV. Iatrogenic injury to the ulnar nerve was greater with the cross‐pinning technique, with RR 0.28 and p=0.03, while the mini‐open technique presented RR 0.14 and p=0.2. A statistically significant greater loss of reduction in the lateral pinning was observed in SFH Gartland III and IV(p=0.04),. ConclusionBased upon this meta‐analysis of prospective randomized clinical trials, the following is recommended: (1) percutaneous pinning with lateral wires in supracondylar fractures of the humerus in children classified as Gartland II type B; (2) Use of crossed wires for Gartland type III or IV, using the mini‐open technique for the medial wire.

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

BackgroundSeverely displaced supracondylar fractures of the humerus in children are frequently associated with complications including neurovascular injuries, non-union, or compartment syndrome. In the current literature, no report exists about postoperative brachial artery entrapment in combination with an inconspicuous preoperative neurovascular examination.Case presentationWe present a case of a 6-year-old white boy with a pulseless radial and ulnar artery after open reduction and internal fixation of a severely displaced supracondylar fracture of his right humerus (Gartland type III) using four K-wires. Remarkably, the preoperative neurovascular examination was inconspicuous. Doppler ultrasound of his brachial artery revealed no pulse when his elbow was in flexion and a faint pulse when it was in full extension 10 hours postoperatively. Revision surgery was performed immediately. On intraoperative examination, a kinking of his brachial artery caused by an entrapment of the tunica externa in the reduced fracture was seen and the artery was released by microsurgical arteriolysis immediately. At the final follow-up examination, positive palpable pulse with good capillary filling and, according to Flynn’s criteria, an excellent recovery of elbow function was observed 3 months postoperatively.ConclusionsThis case demonstrates a rare complication of postoperative artery entrapment with inconspicuous preoperative neurovascular examination. It strongly emphasizes the need for a standardized postoperative neurovascular assessment with fully flexed as well as fully extended elbow.