Open Supracondylar Fracture Research Articles

The Pediatric Open Supracondylar Fracture: Associated Injuries and Surgical Management.

While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures. The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and the study group, those with open injuries. Study variables were age, sex, weight, injury severity score, length of stay (LOS), nerve injury, ipsilateral forearm fracture, compartment syndrome/fasciotomy, requirement for a vascular procedure. Other variables were mode of treatment, provisional reduction, repeat reduction, time interval between referring facility admission and operation, and time from emergency department admission to operation. A total of 4308 subjects were included, 104 (2.4%) of whom had an open SC fracture. LOS was 2 days for the study group versus 1 day for controls (P<0.001). Open SC fractures were more likely than closed to be associated with a nerve injury (13.5% vs. 3.7%), ipsilateral forearm fracture (18.3% vs. 6.4%) and/or a vascular procedure (6.7% vs. 0.3%) (P<0.001). 5.9% of those in the study group required repeat surgery compared with 0.4% for controls (P<0.001). Time from emergency department admission to operation was 3.2 versus 10.3 hours (P<0.001). We report the largest series to date of open SC fractures in children. Surgeons caring for such patients should be aware of their increased risks for both associated injuries and potential requirement for vascular reconstruction. The majority of children with an open SC fracture are managed with 1 operation and in the absence of vascular injury, seldom require an extended LOS. Level III-retrospective cohort study.

“A journey from doom to bloom” – A rare case of low-energy pediatric open supracondylar fracture of humerus with brachial artery laceration managed with “Orthoplastic Approach”

Supracondylar fracture of the humerus (SFH) is the most common fracture of the elbow in the pediatric population (60%). The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability, and commonly, it is associated with road traffic accidents (RTAs) and occupational injuries. However, brachial artery injury in the pediatric age group is not very frequent as in adults and commonly associated with SFH. Long-term sequelae of ischemia in the forearm such as Volkmann's ischemic contracture may prove disastrous. Early aggressive management in terms of exploration of the brachial artery is recommended by Blakey et al., to prevent such serious complications. Arterial injury ranges anywhere from vascular contusion and intimal damage, to complete arterial transaction. Low-velocity injuries such as falls or sports injuries can cause isolated Type 1 open fractures (Gustilo and Anderson classification of open fractures). Open supracondylar fracture complicated by brachial artery laceration is usually seen in high-velocity injuries such as RTA and is usually a part of multiple injuries sustained in such patients. However, in search of literature, we have not found an isolated Type 3 open supracondylar fracture with brachial artery laceration following a fall from a speeding bicycle, which is considered as a low-energy trauma. This patient was managed with reduction and fixation of the fracture with crossed K-wires and repair of the brachial artery with interpositional reversed saphenous vein graft to save the limb.

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Reconstruction of Traumatic, Open Supracondylar Femoral Fractures by Autologous Fibular Strut Grafting and Cortico-Cancellous Bone Grafting-A Single-Centre, Observational Study.

To study the safety and efficacy of staged reconstruction of distal femoral (supracondylar) bone loss using autologous fibular strut, cortico-cancellous bone grafting. Single-centre, observational study, with review of literature. Urban Level I Trauma Center. Eighteen consecutive patients (mean age: 35 ± 8.5 years, all males) with open supracondylar fracture and intercondylar extension (OTA/AO type C3), operated between January 2010 and February 2014 with severe bone loss in 11 patients and moderate loss in 7. Single free fibular strut was used in 12 femurs and dual fibula in 5 femurs with autologous cortico-cancellous bone grafting in all. Clinical union, radiological union, and knee function using the Sanders' score. Mean follow-up was 45.5 ± 17 months. The mean radiological union time was 18 ± 2.6 weeks. Functional assessment after union revealed one patient with excellent knee function, 9 with good, 8 with fair, function according to Sanders' scoring. The mean knee range was 49 degrees (range 5-110 degrees) in which 9 patients achieved a knee range >80 degrees. Mean limb shortening was 2 cm (range 0-7 cm). No limb shortening was observed in 5 patients. Patients were pain free and had no significant graft or donor site morbidity. Staged fibular strut grafting, cortico-cancellous bone grafting for traumatic open supracondylar femoral fractures with significant bone loss is a promising technique with a good safety profile and long-term efficacy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The use of locked plate as a definitive fixation for open supracondylar fracture of the femur with partial bone loss in polytraumatized patients

Background Open supracondylar fractures of the femur are complex injuries usually presenting in a polytraumatized patient. Partial circumferential bone loss may result at the time of injury or during debridement. The way in which the fracture is treated has a substantial influence on the local mechanical and biological environment, which in turn will influence the quantity and quality of the osteogenic response. Although early skeletal stabilization can stop the cycle of injury, remove nidus for infection, and halt ongoing hemorrhage, it may be prudent to delay definitive surgery until the patient’s general condition is optimized. Meanwhile, debridement and a preliminary spanning external fixator is used to stabilize the fracture. The use of a locked plate for the fixation of supracondylar fracture of the femur with partial bone loss creates a rigid biomechanical environment needed for healing and maintenance of alignment until fracture healing. Patients and methods Eighteen patients with open supracondylar fracture of the femur were treated between January 2009 and June 2011. All patients were treated surgically within the first 24 h. Radical soft tissue and bone debridement was performed. Thirteen patients underwent definitive fracture fixation using a laterally placed locked distal femur plate. Five patients had their fractures primarily stabilized by an external fixator until improvement of their general condition. Results Bone healing was obvious on follow-up radiographs in 10 patients without the need for supplementary surgical procedures at a mean of 16 (12–20) weeks. Seven patients with no progressive radiologic healing by 20 weeks’ follow-up underwent an iliac crest cancellous bone graft; healing was then realized radiologically after a mean of 12 (8–18) weeks. Using the IOWA knee functional score for final patient assessment, we found excellent results in 14 patients, good results in three patients, and fair results in one patient. Conclusion Generally stable polytraumatized patients should be treated with thorough initial debridement, local antibiotics, and early definitive fracture fixation using a locked distal femur plate. Critically unstable patients with hemorrhagic shock are to be treated with damage control until improvement in their general condition. Bone graft is to be delayed for 20 weeks as many fractures would successfully heal by that time, even with partial bone loss.

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV) has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In situations where the brachial artery is compromised and needs repair with a bypass, the basilic vein should be considered as a conduit for its greater accessibility and long-term patency.

A Unique Modality for treating Open Supracondylar fracture Femur with Bone Loss. (Gustillo Anderson – 3B)

Background: Various treatment modalities are used for the treatment of GA-3B injury, yet determining the choice of treatment is difficult. We report fifteen such cases, of which twelve were treated with DCS and 950 plate and three with LCP because of minimal bone stock at the distal end (condyles) along with non- vascularised dual ipsilateral fibular strut graft and cancellous bone grafts from iliac crest. Materials and Methods: We performed this study from 2000 – 2014. We studied Total 1176 cases of supracondylar fracture femur of which 15 were of type GA-3B. The study consisted of eight males and seven females, eleven were right sided and four left sided. Fifteen patients underwent surgery (twelve were treated with DCS and 950 plate, three with LCP plate) with dual ipsilateral fibular strut graft and cancellous bone graft from iliac crest. Thirteen had functional range of movement (avg 0-1170), one had range of movement 0-70o and one had range of movement 0-15o at knee joint. Fractures united in all fifteen patients with average period of union twelve weeks and all returned to previous work. Immediate treatment consisted of debridement, primary closure, proximal tibial skeletal traction and broad spectrum i/v antibiotics. Once the wound was healed, surgery (open reduction internal fixation (ORIF) with plating with ipsilateral dual fibular strut grafts and cancellous graft) was performed. Result and Conclusion: We performed two-stage surgery in all the cases. First in the form of debridement and skeletal traction and secondly, definitive fixation was carried out. The current study demonstrated that ORIF with (DCS and 950 / LCP) plate with dual ipsilateral non-vascularised fibular strut graft and cancellous bone grafts from iliac crest is a good modality for open supracondylar fracture femur with bone loss with good results and functional range of movement. This is a small study with favorable results. However, it requires large study group to prove this technique beneficial for treating such fractures. Keywords: GA-3B, bone loss, fibular strut graft, iliac graft, 95 DCS, LCP.

Complicated Open Supracondylar Fracture of the Femur Managed Primarily with an Autogenous Split Fibular Graft in Conjunction with an Intramedullary Nail: A Case Report.

A thirty-two-year-old man presented with an open type-IIIA Müller type-C2 supracondylar fracture of the femur and an ipsilateral segmental fracture of the tibia. An external fixator was used for initial stabilization. After ten days, the fractured femur was stabilized with a retrograde intramedullary nail along with an autogenous split fibular graft placed on either side of the nail; intramedullary nail fixation of the tibia was also performed. At the two-year follow-up, both fractures had united. An autogenous split fibular graft in conjunction with an intramedullary nail is a viable option to manage bone defects in complicated supracondylar fractures of the femur.

Transected brachial artery with pink pulseless perfused limb in an open grade III supracondylar fracture of humerus: A case report and review of literature

The incidence of brachial artery injuries in grade 3 supracondylar fractures of the humerus has been reported to be 3—12%. The vascular injury may beduetothrombosiswith intimal tear,brachialartery entrapment in the fracture site, compression of the artery due to deformity or swelling and partial or complete transection of the artery. Very rarely the artery is transected by the impaling spike of the fractured bone. Immediate vascular reconstruction is required to ensure a functional recovery of the limb. We report a rare case of complete transection of the brachial artery following an open supracondylar fracture treatedwithvenousgraftand fasciotomy.

Results of Immediate Internal Fixation of Open Supracondylar Fractures of the Femur

s Presented at the Sixth Annual Meeting of the Orthopaedic Trauma Association: Toronto, Canada, November 7–10, 1990: PDF Only