Supracondylar Fractures Of The Humerus Research Articles

Management of Pediatric Supracondylar Humerus Fractures Using Lateral Cross-Wiring Technique Under Fluoroscopic Guidance.

Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and fixation using percutaneous Kirschner wires. The lateral cross-wiring technique has demonstrated favorable functional and cosmetic outcomes, thereby reducing the incidence of ulnar nerve injury. This study aimed to assess the efficacy of the lateral cross-wiring technique in achieving optimal functional and cosmetic recovery while mitigating the risk of ulnar nerve injury in pediatric patients with displaced supracondylar humeral fractures. A prospective analysis was conducted on 48 patients who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type III, including extension and flexion types) of the humerus. Follow-up assessments were performed over a minimum period of eight months post-surgery. Among the 48 patients, all demonstrated satisfactory restoration of the carrying angle and functional ability postoperatively. Notably, no iatrogenic cases of radial or ulnar nerve injury were observed during the follow-up period. The lateral cross-wiring technique emerges as an effective treatment option for displaced supracondylar fractures of the humerus in pediatric patients. It facilitates both functional and cosmetic recovery while concurrently reducing the risk of ulnar nerve injury, thus warranting consideration in the management of such fractures.

Minimally invasive surgical technique for unstable supracondylar humerus fractures in children (Gartland type III or IV).

Achieving and maintaining anatomical reduction during the treatment of pediatric humerus fractures, classified as Gartland type III or IV, presents a clinical challenge. Herein, we present a minimally invasive surgical approach using a novel and simple K-wire push technique that aids in achieving and maintaining anatomical reduction. We reviewed data of children receiving treatment for supracondylar fractures of the humerus at our hospital between January 2016 and December 2020. Patients were divided into two groups based on the method of treatment: Group 1 was treated with the K-wire push technique, and Group 2 was treated with the standard technique as described by Rockwood and Wilkins. The medical records and radiographic images were reviewed. In total, 91 patients with Gartland types III and IV fractures were included, with 37 and 54 patients in Groups 1 and 2, respectively. The postoperative reduction radiographic parameters and Flynn scores at final follow-up were not significantly different between the two groups. The minimally invasive K-wire push technique for unstable supracondylar fractures in children is a safe and effective alternative for improving reduction. Using this technique, complications can be minimized, and the requirement for open reduction can be reduced.

The Functional Outcome of Closed Reduction Percutaneous K-Wire Fixation of Type 3 Supracondylar Humerus Fractures

Background: Supracondylar fractures of the humerus are among the most common pediatric fractures, accounting for a significant portion of elbow injuries in children. The management of these fractures, especially Type III fractures which are completely displaced, poses a challenge due to the potential for serious complications and difficulties in achieving satisfactory reduction. The current standard treatment involves closed reduction and percutaneous pinning under fluoroscopic guidance. However, delays in presentation and treatment can complicate outcomes, particularly in resource-limited settings. Objective: The objective of this study was to evaluate the safety and effectiveness of closed reduction and percutaneous K-wire fixation in children presenting with Type III supracondylar humerus fractures after a delay. Methods: This descriptive case series was conducted at Lady Reading Hospital MTI, Peshawar, from February 2023 to February 2024. A total of 84 patients aged 3-10 years with Type III supracondylar humerus fractures were included. Patients with neurovascular complications at presentation, other types of fractures, or those with multiple traumas were excluded. The study utilized non-probability, consecutive sampling. Procedures were performed under general anesthesia with fluoroscopic guidance, and outcomes were assessed using Flynn's criteria. Data analysis was conducted using SPSS version 25. Results: Of the 84 patients, 45.2% were male and 54.8% were female. The age distribution was 36.9% for ages 3-5 years, 38.1% for ages 6-7 years, and 25% for ages 8-10 years. Closed reduction and percutaneous pinning were successful in 90% of the cases, with only 10% requiring conversion to open reduction. Flynn's criteria indicated that 31 patients (36.9%) achieved excellent outcomes, 23 (27.4%) good, 10 (11.9%) fair, and 20 (23.8%) poor. The rate of pin tract infection was 7.5%. Conclusion: The study concludes that closed reduction and percutaneous pinning is a safe and effective method for treating children with delayed presentation of Type III supracondylar humerus fractures. Despite the delay in treatment, the majority of patients achieved favorable functional outcomes with a low incidence of complications.

Paediatric supracondylar fractures: assessment and management.

Supracondylar fractures of the distal humerus are the most common fracture around the elbow in children. A thorough initial assessment must be conducted to identify any associated neurovascular injury and carefully documented. The assessment should include a vascular examination of the radial pulse, temperature, colour and capillary refill time. A neurological examination must comment on the motor and sensory function of the radial, median and ulnar nerves. X-rays allow an evaluation of the fracture location and type, and the degree of displacement. Immobilisation in plaster is the gold standard treatment for paediatric supracondylar fracture of the humerus where the degree of displacement is within acceptable parameters. Casting should be followed by orthogonal radiographs and a repeat neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge, and the child reviewed in a fracture clinic within 1 week of the injury. The British Orthopaedic Association Standards for Trauma and Orthopaedics for supracondylar fractures of the humerus in children are useful for junior orthopaedic and emergency medicine clinicians to refer to when dealing with these injuries.

Epidemiology of Supracondylar Fractures of the Humerus in Children

Background: Supracondylar fracture of the humerus are the second most common fracture in pediatric patients. There are few studies concerning their epidemiology in Brazil. This study aims to assess the clinical and epidemiological characteristics of supracondylar fractures of the humerus in children managed at a tertiary-level hospital within the Brazilian Unified Health System (translation for SUS - Sistema Público de Saúde). Methods: This retrospective study included patients younger than 13 years diagnosed with supracondylar fracture of the humerus assisted at an urgent and emergency referral unit of the Unified Health System from June 2022 to July 2023. The statistical analysis used R software version 4.0.4 with a significance level set at 0.05 using descriptive and inferential statistics. Results: 197 children with mean age of 5.4 years (2.4) were diagnosed with a supracondylar fracture of the humerus. The highest temporal incidence occurred in December, being 56.9% male patients, 81.3% identified as African American, and 51.8% had a fracture on the left side. The most prevalent cause for the fracture was a fall from standing height on the outstretched hand. At least 95% of the patients had extension fractures, and the distribution by Gartland classification was: I, 36.7%; II, 26.2%; III, 30.9%; and IV, 6.3%. Three patients had a neurological injury. All patients with III and IV fractures, as well as those with flexion fractures, underwent surgery. However, of the 50 patients with grade II fractures, 11 underwent surgery, and 39 managed with nonoperative methods. We observed an association between the fracture severity, and fall height, neurological impairment, and management received. Conclusion: Targeted education efforts and interventions can prevent the occurrence of supracondylar fractures in our region at the northeast side of the country.

A new technique of intramedullary elastic reduction of the “de-sharpened” Kirschner wire for the treatment of Gartland type III posterolateral displaced supracondylar fracture of the humerus in children

ObjectiveTo compare the clinical effects of intramedullary elastic reduction of the “de-sharpened Kirschner wire and traditional three-dimensional manipulation in the treatment of Gartland type III posterolateral supracondylar fracture of the humerus in children.MethodsA retrospective cohort analysis was made on 106 cases of Gartland type III posterolateral supracondylar fracture of the humerus treated in the Department of Orthopaedics of a Children’s Hospital from March 2020 to March 2022. According to different surgical technology, the patients were divided into two groups: intramedullary elastic reduction of the de-sharpened Kirschner wire group (experimental group, n = 50) and traditional three-dimensional manipulation group (control group, n = 56). The surgical operating time, intraoperative fluoroscopy times, postoperative Baumann angle changes, postoperative elbow function Flynn score, and complications were collected and compared between the two groups.ResultsAll the enrolled cases underwent surgery successfully and were followed-up at least 6 months. The surgical operating time of the experimental group was 32.88 ± 3.69 min and that of the control group was 45.56 ± 10.13 min, and the difference was statistically significant (P < 0.05). The intraoperative fluoroscopy times were 20.62 ± 5.41 times in the experimental group and 32.48 ± 8.20 times in the control group (P < 0.05). The change of Baumann angle in the experimental group after operation was 2.3 ± 1.3 and that in the control group was 6.0 ± 2.1 (P < 0.5). Elbow joint Flynn scoring standard to evaluate the curative effect: the excellent and good rate was 98.00% (49/50) in the experimental group and 92.86% (52/56) in the control group (P > 0.5). There were no complications such as osteomyelitis, compartment syndrome, iatrogenic vascular and nerve injury, and myositis ossificans in either group.ConclusionsGood functional outcome can be obtained with both intramedullary elastic reduction of the de-sharpened Kirschner wire and traditional three-dimensional manipulation for Gartland type III posterolateral displaced supracondylar fracture of the humerus in children; however, the former does not need repeated manipulation, and the operation time is shorter, the number of intraoperative fluoroscopy is less, and the recovery of the Baumann angle is better.

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

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

Evaluation of Gartland Classification, Baumann Angle and Anterior Humeral Line in Paediatrics Supracondylar Fractures: An Inter and Intra-Observer Reliability Study.

Supracondylar fractures of the humerus are frequent paediatric injuries. The aims of this study were to evaluate the applicability and reproducibility of the Gartland and Wilkins classification, the Baumann angle (BA) and the Anterior Humeral Line (AHL). This retrospective monocentric observational study was conducted on 217 patients. Four observers assessed the pre-operative radiographs by applying the Gartland and Wilkins classification and the post-operative X-rays by measuring the BA and AHL. The kappa coefficient (K) and the Cohen's kappa were used for the reliability of the Gartland classification; the Intraclass Correlation Coefficient (ICC) for that of the BA. The AHL was evaluated in a double manner by using first the K and the Cohen's kappa and then the ICC. A total of 186 patients were eligible. Inter-observer reliability for the Gartland classification was K = 0.73-0.61 for type III, 0.65-0.61 for type Ia and 0.43-0.26 for type IIb. The Baumann angle mean value in the first data collection was 73.5 ± 6.85 (inter-observer ICC 0.74) and 72.9 ± 6.83 (inter-observer ICC 0.77) for the second data collection; AHL: inter-observer ICC 0.87 for the first evaluation and 0.80 for the second one. Gartland's classification modified by Wilkins has a high degree of reliability. BA and AHL appear reproducible and reliable.

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

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

Is methyl methacrylate fixator reliable for the treatment of gartland type IV supracondylar fractures?

In childhood supracondylar fractures of the humerus, fixation with percutaneous Kirschner wire is the standard treatment. In the case of irreducible-unstable fractures, these can be defined as fractures in which reduction is not well-achieved or in which fixation cannot be achieved with the K-wire. Intraoperative management of these types of fractures may be difficult. Treatment with a methyl methacrylate fixator consisting of K-wire and methyl methacrylate cement, as defined by the senior author of the article, may be a good option for Gartland type IV supracondylar humeral fractures where the fracture is unstable in flexion and extension due to complete periosteal tearing. The short-term and mid-term results of 27 patients between the ages of 4-12 with Gartland type IV supracondylar fracture of the humerus treated with methyl methacrylate fixation were reviewed. The patients were scored in terms of function and cosmetic satisfaction. A total of 19 of the 27 patients treated with the methyl methacrylate fixator had full elbow motion function and rated the outcome of the treatment as excellent, which was judged by orthopedic surgeons on the basis of Flynn's criteria. Six patients had nearly full elbow motion and evaluated their recovery outcome as good. Two patients reported nearly full range of motion (ROM) and evaluated the method as moderate in terms of treatment. Treatment with the methyl methacrylate fixation method is an inexpensive method that allows early joint mobilization, provides strong biomechanical stability, ensures good outcomes, and should be considered in the treatment of irreducible and unstable supracondylar fractures of the humerus.

FUNCTIONAL OUTCOME OF PERCUTANEOUS TRANSOLECRANON AND LATERAL KIRSCHNER WIRE FIXATION FOR DISPLACED SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN

Background: Supracondylar fracture of the humerus is one of the most common fracture occurring in children. When the patients present with swelling of the elbow, there is a dilemma whether to wait for the swelling to subside or to perform closed reduction and percutaneous pinning immediately. The objective of this study was to assess the functional outcome of percutaneous transolecranon and lateral K wire fixation and to observe the outcomes associated with this K wire configuration. Methods: This was a prospective observational study done between 2021 and 2022 at Chitwan Medical College, Nepal. The study included 40 children with closed Gartland type II and III supracondylar fracture of the humerus with no neurovascular injury. They were treated within 3 days with closed reduction and percutaneous pinning using the transolecranon and lateral K-wire fixation technique. The outcome was assessed using the Flynn’s elbow Grading criteria. Results: At 12 week follow up, 7 (17.5 %) patients had excellent result, 21 (52.5%) patients had good, 8 (20%) patients had fair and 4 (10%) patients had poor result. According to Flynn’s grading system 90 % had satisfactory result and 10 % had unsatisfactory result. Four patients had loss of reduction out of which 2 had poor result and 2 had fair result. None of the patients had post operative iatrogenic ulnar nerve injury. Conclusions: The percutaneous transolecranon and lateral K-wire fixation for displaced supracondylar fracture of the humerus in children is a good treatment option when the elbow is swollen and is reliable as it prevents iatrogenic ulnar nerve injury.

Supracondylar Fractures in Children: A Review of 120 Cases

Supracondylar fractures of the humerus in children are the most common fracture of the elbow. Our work is based on the study of 120 cases of supracondylar humeral fractures collected in the surgery department of the Errachidia Regional Hospital Center between January 2015 and June 2020. The average age of the patients was 6 years old, occurring in 69.1% of cases in boys. The left elbow was most affected (60%), the limb being in flexion in 85.8% of cases. The etiologies were dominated by domestic accidents (70%), with stage III fractures the most frequent (37.5%). Orthopedic treatment was used in 40% of patients and surgery in 60%. Results were satisfactory in 95.9%, poor in 4.1%. The poor results were mainly observed in highly displaced fractures.

Anatomical Variations of the Musculocutaneous Nerve in the Human Fetus

Knowing the motor branches and variations of the musculocutaneous nerve to the muscles along its course will facilitate the treatment of flexor spasticity and supracondylar fractures of the humerus in order to minimize nerve lesion. In fetal cadavers, the purpose of our study was to determine the number and course of the formation variations and motor branches of the musculocutaneous nerve. The significance of studying fetal nerve variations is due to injury to the brachial plexus roots during birth. Our study was conducted using the anatomical dissection technique on 102 upper limbs from 51 fetuses ages ranged from 17 to 40weeks. Throughout its course, the variations and motor branches of the musculocutaneous nerve were analyzed. In 13.7% of cases, the musculocutaneous nerve did not pierce the coracobrachialis. The musculocutaneous nerve gave the muscles 1-3 motor branches. Additionally, motor branches terminated with 1-7 fringes. The biceps brachii motor branches of the musculocutaneous nerve were typed. Accordingly, 15.6% were type 1A, 3.9% were type 1B, 35.4% were type 1C, and 19.6% were type 1D. It was determined that 23.5% of the extremities were type 2 and that 1.9% were type 3. The distance between the musculocutaneous nerve's motor branches and the acromion was proportional to the arm's length. There were no statistically significant differences between the sides and genders for any measurement. Our study's findings will aid in the diagnosis and treatment of pediatrics, orthopedics, surgical sciences, and radiology conditions. It reduces the risk of iatrogenic injury and postoperative complications. We also believe that our research will serve as a resource for anatomists and other scientists.

Retracted: Application Value of Elbow Pressing Method Combined with Zhongtong Ling Application in Children with Swelling and Pain after Operation of Supracondylar Fracture of the Humerus.

[This retracts the article DOI: 10.1155/2022/8594443.].

Median to Radial Nerve Transfer: An 8-Year Experience From a Lower-Middle Income Country

IntroductionWith an incidence of 2-16%, radial nerve palsy is one of the common forms of nerve injuries globally. Radial nerve palsy causes debilitating effects including loss of elbow extension, wrist drop and loss of finger extension. Reparative surgical pathways range from primary repair and neurolysis, to nerve grafting, nerve transfers, and tendon transfers. Due to ease of performance and acceptability and reproducibility of outcomes, tendon transfers are considered the gold standard of radial nerve palsy repair. However, independent finger function cannot be achieved and as such may not give truly desirable results. In lower-middle income countries, the question of nerve transfer versus tendon transfer for patients who are keen to get back to work is key. While tendon transfer recovery is faster, the functional loss is often considered devastating for fine hand function due to loss of grip secondary to lack of wrist and finger extension. In this study, we present our experience of performing median nerve transfers for radial nerve palsy in Pakistan. MethodsWe performed a retrospective case-series of patients undergoing median to radial nerve transfer for radial nerve palsy over a period of 6 y, from 2012 to 2019. Patients with radial nerve palsy were diagnosed via electromyography and nerve conduction studies. The procedure involved coapting the branches of the flexor carpi radialis and flexor digitorum superficialis (long and ring finger) nerves to the posterior interosseous nerve and extensor carpi radialis brevis, respectively. Patients were assessed using the Medical Research Council scale for muscle strength of wrist, finger and thumb extension separately at 1 y time. Our results were then compared to results from similar nerve transfer studies. ResultsWe operated on 10 right-hand dominant patients, eight males and two females with a median age of 33 y (6-63 y). four sustained injury to the right hand and six to the left. Causes of the injuries included road traffic accident (n = 3), firearm injury (n = 4), shrapnel (n = 1), iatrogenic injury (injection in deltoid region (n = 1) and fall (n = 1). Types of fracture included mid humerus fracture, fracture of the surgical neck of the humerus, and supracondylar fracture of the humerus. Median time to surgery since injury was 4 mo (1-8 mo). Independent wrist extension was M4+ in all patients and independent finger extension was M4+ in seven and M4-in two patients. However, a patient who presented late at 8 mo had poorer finger outcomes with extension at M2-. All patients had independent movement of fingers. ConclusionsNerve transfer is a reliable method of post traumatic nerve repair and reinnervation, particularly in lower-middle income countries, even in cases where the nerve damage is severe and extensive and up to 6 mo may have elapsed between injury and presentation. Timely median to radial nerve transfer is a highly recommended option for radial nerve palsy, with regular follow-ups and physical therapy added to ensure positive outcomes.

Pediatric Supracondylar Fracture of the Humerus with Sideward Displacement

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction.

The Influence of Surgical Intervention Time for Supracondylar Fractures of the Humerus in Children

Supracondylar fractures of the humerus are the most common elbow fracture injuries in children. Despite the frequency of these injuries, vascular and orthopaedic surgeons have long debated the management of these fractures. This study aims to look at the effects of the surgical intervention time on how the patient is treated and the complications after surgery. This is a retrospective study of children under 12 years of age who received hospital care due to a supracondylar fracture of the humerus at the University Trauma Hospital for the period January 2021 - November 2022. Data analysis for the 90 patients considered shows that the time of surgical intervention varies from 0 to 13 days, with an average of 1.6 days. The analytical results show that there is a negative relationship between the time of surgical intervention and the method of treatment; for patients who were treated with “closed repair and plaster cast", the time of surgical intervention is about 2.2 days less than for patients treated with "open reduction stabilised with K-wires" (p-value=0.00) while this time decreases up to 0.5 days for patients treated with "closed reduction stabilised with K-wires" (p-value=0.09). Also, the analytical results show that patients with longer surgical time intervention had complications (p-value = 0.00), emphasising the importance of surgical time intervention. The results of the study show that the average time intervention for these fractures at the University Trauma Hospital in Tirana is relatively high compared to the existing literature, thus increasing the possibility of complications and the patient's well-being. Keywords: Supracondylar fractures of humerus, elbow fracture, children.

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

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

Stabilization of Recurrent Elbow Instability in the Presence of Hyperlaxity in Children Using a Nonanatomic Soft Tissue Reconstruction.

Despite growing concordance of opinion in the adult setting, pediatric elbow instability and its management are poorly represented in the literature due to its low prevalence and often unique circumstances. The authors present a case of posttraumatic recurrent posterior pediatric elbow instability in a patient with joint hypermobility. Our patient, a 9-year-old girl, sustained a right-sided supracondylar fracture of the humerus in April 2019. Having been managed operatively, the elbow remained unstable and dislocated posteriorly in extension. Definitive surgical management was designed to provide a stable functional elbow. The principle of the surgery was to create a checkrein of tissue, not changing in length in extension and flexion, and to prevent further posterior elbow instability. A 3mm slip of the central triceps tendon was dissected, leaving its attachment to the olecranon tip. Gracilis allograft was sutured to the strip of the triceps tendon to increase the tensile properties of the native tendon graft using a braided nonabsorbable suture. The tendon construct was then passed through a window made in the olecranon fossa and a transosseous tunnel in the ulna from the coronoid tip to the dorsal cortex. The tendon was tensioned and secured to the radial-dorsal aspect of the ulna with a nonabsorbable suture anchor in 90 degrees of flexion. At one year follow-up, the patient has a stable and pain-free elbow joint with no functional limitations.

Differences in Carrying Angle, Baumann’s Angle, Anterior Humeral Line and Dash Score between Children in the Age Group of Less than 5 Years and over 5 Years at 3 Months Post Open Reduction Internal Fixation Criss-Cross Wire Fracture Supracondylar Humerus Gartland Type III

Introduction: Supracondylar humerus fracture is one of the most found fractures in children. In addition to adequate fixation, the role of age differences in the clinical outcomes of operative treatment of supracondylar humeral fractures is still a matter of debate. This study aimed to compare the clinical and radiological outcome of surgery in cases of Gartland type III supracondylar humerus fracture. Materials and Methods: This study used a cross-sectional design on the population of patient with Gartland type III supracondylar fracture. Patients were divided into 2 groups: age &lt;5 years old (Group 1) and &gt;5 years old (Group 2). The evaluation was carried out 3 months after surgery with open reduction internal fixation crisscross wire. The parameters assessed were Baumann’s angle, carrying angle, and anterior humeral line, and Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Difference between group were analyzed using the chi-square test. Results: There were a total of 34 patients included in this study. Patients &gt;5 years old had a 1.85 times greater chance to have a post-operative carrying angle of &gt;15o (95% CI 0.993-3.474; p = 0.037) and 2.75 times greater chance to result in post-operative Baumann’s angle &gt;80o (95% CI 1,089-6,943, p=0.037). There were no significant differences in anterior humeral line (p=1) and DASH score (p=0.244) between groups. Conclusion: The result of surgery in supracondylar fracture of the humerus over 5 years old tend to have worse radiological outcome (carrying angle and Baumann’s angle) than patient younger than 5 years old. Thus, treatment of supracondylar fractures of the humerus aged more than 5 years requires more attention with adequate reduction and vigilance against complications that can affect the bone growth of pediatric patients.