Supracondylar Fractures In Children Research Articles

Outcome of displaced supracondylar fractures in children after manipulation and backslab

AIM: To assess the functional and cosmetic outcome of displaced supracondylar fractures in children treated by closed reduction and plaster backslab. METHOD: We retrospectively reviewed 53 patients with Gartland type II and type III fractures that were treated by closed reduction (Blount's technique) and immobilisation in a collar and cuff and above-elbow plaster backslab between December 2011 and May 2012. The mean age was 6.6 years. The mean follow-up time was 12 weeks (range, 6-20). All open injuries and undisplaced fractures were excluded from the study. Flynn's criteria were used to assess functional and cosmetic outcome. RESULTS: The median loss of motion was 10 degrees and the median change in carrying angle was 4 degrees. Fifty-one patients (96.2%) had satisfactory results, with 87% graded as excellent or good according to the Flynn's criteria for grading of the carrying angle. A range of motion of 100 degrees was achieved in 92.5% of patients at 12 weeks. CONCLUSION: This method appears to produce less satisfactory results in comparison to closed reduction and fixation with Kirschner wires (K-wires), but it does provide satisfactory results according to Flynn criteria with regard to cosmetic deformity and range of motion at short-term follow-up. It is an acceptable and safe option with which to treat displaced supracondylar fractures.

Lateral three pin fixation for supracondylar fractures in children

Introduction: Paediatric Supracondylar fractures are the commonest elbow injuries encountered in the emergency departments. Most commonly they are the result of a fall on an outstretched hand that causes hyperextension of the elbow. The extension-type supracondylar humeral fractures account for 95% to 98% of all supracondylar fractures. Displaced fractures are treated with closed reduction and percutaneous pinning. However the method of pinning has been a matter of debate (lateral entry vs cross pinning). The issue with the lateral entry pinning like loss of reduction and ulnar nerve injury with the cross pinning method has always kept a doubt in the surgeons mind regarding the method of pinning. The present study was aimed to see functional results of using three lateral pins in type II and III supracondylar fractures and to look for any complications occurring thereafter. Methods: Forty consecutive patients of type II and III SC fractures were taken up for the study. Three lateral pins were used for all fractures. Using the Flynn criteria, the results were graded as excellent, good, fair or poor by comparing the carrying angle and range of motion with the opposite side. Results: Among the cohort of forty patients we had 25 males and 15 females. The mean age group was 6.5 + 3.2. Sixteen patients had type II fracture while as 24 had type III Gartlands fracture. The union occurred in all cases. At the final follow up, 87.5% patients showed excellent results 10% showed good and 2.5% fair results. There was no case of poor results. There were no iatrogenic nerve palsies, and no patient required additional surgery. Conclusion: Lateral three pin fixation is a good method for displaced supracondylar fractures and has little or no chances for ulnar nerve injury. This method has an easy learning curve among orthopaedic residents. A randomised control trail comparing it with other methods involving a larger series is needed to look for the effectiveness of this technique.

Preliminary view on new roentgenologic trochleocapitellar index for assessment accuracy of the reduction supracondylar fracture of the elbow in children to comparison Baumann's angle

Abstract Background: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own

Facteurs associés aux échecs de réduction orthopédique des fractures supra-condylienne de l’enfant

Purpose of the studyThe aim of this retrospective study is to analyze the risk factors causing the failure of closed reduction of children supracondylar fracture. Materials and methodsThe children with supracondylar humerus fractures who were treated in our hospital from February 2008 to February 2013, were recorded as well as their age, sex, BMI, injured side, mechanism of injury, associated injuries, fracture type, delay from injury to surgery. Mean comparisons or chi-square test were used for univariate analysis of the above factors, and then multivariate logistic regression analysis was used to analyze the possible risk factors, in order to elicit the risk factors associated with a failed closed reduction for supracondylar fractures in children. ResultsUnivariate analysis showed that BMI, fracture type, duration from injury to surgery, and mechanism of injury had statistically significant association with the failure of closed reduction for children supracondylar fracture (P=0.021, 0.044, 0.000 and 0.037 respectively). Multivariate logistic regression analysis demonstrated that fracture type (P=0.027, OR=1.177), time from injury to surgery (P=0.022, OR=2.003), and mechanism of injury (P=0.044, OR=4.182) were independent risk factors of a failed closed reduction for paediatric supracondylar fractures. DiscusionsGartland type III supracondylar fractures, the peak period of soft tissue swelling and high-energy injury are significant risk factors to warrant open reduction. Treating surgeons should preoperatively carefully evaluate these risk factors and be prepared to treat these injuries accordingly. Level of evidenceLevel IV retrospective study.

Factors associated with a failed closed reduction for supracondylar fractures in children

Purpose of the studyThe aim of this retrospective study is to analyze the risk factors causing the failure of closed reduction of children supracondylar fracture. Patients and methodsThe children with supracondylar humerus fractures who were treated in our hospital from February 2008 to February 2013, were recorded as well as their age, sex, BMI, injured side, mechanism of injury, associated injuries, fracture type, delay from injury to surgery. Mean comparisons or Chi2 test were used for univariate analysis of the above factors, and then multivariate logistic regression analysis was used to analyse the possible risk factors, in order to elicit the risk factors associated with a failed closed reduction for supracondylar fractures in children. ResultsUnivariate analysis showed that BMI, fracture type, duration from injury to surgery, and mechanism of injury had statistically significant association with the failure of closed reduction for children supracondylar fracture (*P=0.021, 0.044, 0.000 and 0.037 respectively). Multivariate logistic regression analysis demonstrated that fracture type (P=0.027, OR=1.177), time from injury to surgery (P=0.022, OR=2.003), and mechanism of injury (P=0.044, OR=4.182) were independent risk factors of a failed closed reduction for paediatric supracondylar fractures. DiscussionsGartland type III supracondylar fractures, the peak period of soft tissue swelling and high-energy injury are significant risk factors to warrant open reduction. Treating surgeons should preoperatively carefully evaluate these risk factors and be prepared to treat these injuries accordingly. Level of evidenceLevel IV retrospective study.

Ulnar Nerve Monitoring During Percutaneous Pinning of Supracondylar Fractures in Children

Supracondylar fractures of the humerus in children are frequently managed by closed reduction and percutaneous pinning. Insertion of medial and lateral pins is more stable than lateral pinning alone, but carries an increased risk for ulnar nerve damage. This study describes the use of electrical stimulation concurrent with medial pin insertion as a monitoring technique for avoiding iatrogenic ulnar nerve injury. A retrospective review was conducted on 138 children, mean age 5.6 years (SD±2.5), who were admitted to the hospital between 2007 and 2010 with uncomplicated supracondylar fractures, Gartland type II and above, and intact neurovascular presentation. The location of the ulnar nerve was identified and marked preoperatively by observing twitch contractions in response to electrical stimulation. The medial pin served as an active electrode during pin insertion, and repeated stimulation throughout the insertion process ensured no contact with the response of the ulnar nerve. After pin insertion, ulnar nerve stimulation was used again to ensure nerve continuity viability. All fractures were stabilized with 2 to 4 cross K-wires (size 1.6 mm), with number depending on stability of the fracture. The children were discharged home 2 days after fracture fixation, with no iatrogenic ulnar nerve injury observed in any of the children. The only postoperative complication involved 2 cases of anterior interosseus nerve neuropraxia, which resolved spontaneously after 4 to 6 months. Primary fracture healing was achieved without nonunions or delayed unions in all cases. Ulnar nerve stimulation before and during the percutaneous pinning of supracondylar fractures in children is a simple, economical, and easy-to-implement technique that can prevent iatrogenic ulnar nerve injury. Level IV.

Percutaneous lateral cross-pinning of paediatric supracondylar humeral fractures

Introduction The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The aim of this study was to study the results of a cross-wiring technique, achieved solely from the lateral side, in an effort to reduce the risk of ulnar nerve injury. Patients and methods Thirty-two cases of displaced supracondylar humeral fractures were treated by the closed reduction and lateral cross-pinning technique. The mean age of the patients was 6 years (range; 4-12). All fractures were of the extension type (Gartland's types II and III). Results The mean follow-up period was 12 months (range; 9-20 months). Using the cosmetic and functional criteria of Flynn and colleagues, cosmetically, 93.8% of the cases achieved a satisfactory outcome and 6.2% achieved fair results with mild cubitus varus. Functionally, 87.5% of the cases achieved satisfactory results and 12.5% achieved unsatisfactory results. Radiologically, all fractures united. The humeral shaft-condylar angle was normal in 90.7% and Baumann's angle was normal in all except two cases. There was no case of secondary displacement. Most complications were mild pin-site problems. There were no iatrogenic nerve injuries. Conclusion The lateral cross-pinning technique offers fracture stability and ulnar nerve safety. It could be considered as a viable option for treating displaced supracondylar fractures in children.

Ultrasound diagnosis of supracondylar fractures in children.

The objective of our study was to evaluate the safety and accuracy of ultrasound (US) compared to standard radiographs in diagnosing supracondylar fractures (SCFs) of the humerus in children. A total of 106 children (aged between 1 and 13years) with clinically suspected SCF of the humerus were primarily examined by US followed by standard two-plane radiographs of the elbow. US was conducted with a linear scanner viewing the distal humerus from seven standardized sectional planes. US fracture diagnosis was established either by a cortical bulging or cortical gap, or by a positive dorsal fat pad (dFP) sign. X-ray diagnosis was stated by an independent pediatric radiologist and, afterwards, compared to our US findings. Sonographic and radiographic findings were collected in a contingency table. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for US fracture diagnosis were calculated according to the radiographs. In addition, by identifying significant angulation and/or disrupture, SCFs were classified as non-operative/stable and operative/instable SCFs according to the AO Pediatric Fracture Classification System. By US, a SCF could be excluded in 43 patients and in 63 patients, a fracture was diagnosed. In contrast, by radiographs, an SCF could be excluded in 46 patients and in 60 patients, a fracture was diagnosed. For US fracture diagnosis in comparison to radiographs, we calculated a sensitivity of 100%, a specificity of 93.5%, an NPV of 100%, and a PPV of 95.2%. Thirty-nine SCFs were sonographically classified as stable grades 1/2 SCFs and confirmed in 37 patients by X-rays. All four operative/instable SCFs were correctly identified by US. By identifying a positive dFP sign and/or cortical lesions of the distal humerus, SCFs can be detected very sensitively by US. Even the estimation of fracture displacement seems to be possible. We suggest US as an applicable alternative method in the primary evaluation of suspected SCF in children, guiding further diagnostics, where appropriate. After minor injuries, if clinical assessment for an elbow fracture is low and US examination is negative for fracture, additional radiographs are dispensable. Thereby, the amount of X-ray burden during childhood can be reduced, without loss of diagnostic safety.

SUPRA CONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN;

Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients presentvery late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years withsupra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried outand necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation bytraditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% wereType I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositisossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displacedsupracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by OpenReduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocolhad to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full rangeof movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction andlifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus inchildren different management protocols have to be made, tailored to individual needs of the patient.

Simple bracket assist closed reduction percutaneous treatment of children's supracondylar fracture

Objective Describes the use of homemade simple bedside bracket of children supracondylar fracture closed reduction and percutaneous pin fixed surgical methods and clinical effects.Methods 16 cases of children supracondylar fractures Gartland type Ⅱ cases,15 cases Gartland type Ⅲ,13 males and 3 females,with an average age of 6 years old,all patients used our hospital homemade simple bedside shelf assisted closed reduction,percutaneous pin fixation,and fixed with plaster immobilization.Results 16 patients were followed-up,in addition to the two cases of pin tract infection,fracture all were healed smoothly.Without iatrogenic nerve injury and internal fixation loosening,and also no volkmann contracture,and myositis ossificans etc complications.The average fracture healing time for three weeks,no bone delayed union or nonunion occurred.According to Flynn clinical function evaluation,there were excellent in 7 cases,good in 9 cases.Conclusion Useing homemade simple bedside shelf to children supracondylar fractures closed reduction and percutaneous Kirschner wire fixed can ensure the efficacy,and also simplify the surgical procedure,reduce radiation intake,which is the worthy of clinical practice. Key words: Humeral fractures; Closed reduction; Fractures fixation; Bracket ; Child

Surgical Outcomes of Pediatric Humeral Supracondylar Fractures Treated By Posterior Approach and Triceps Splitting

Background: A significant number of complications that maybe occur with surgical treatment of humeral supracondylar fractures in children are approach related. In this study we tried to compare the outcome of triceps splitting (posterior approach) with other approaches. Methods: Thirty six consecutive children with displaced Gartland Type III extension supracondylar fractures underwent open reduction and internal fixation in our university hospital from March 2005 to March 2011. They were divided into three groups on the basis of surgical approach; Group A (14 patients) posterior approach with triceps splitting, Group B (10patients) posterior approach with tongue shape flap, and Group C (12 patients) lateral, anterolateral, or medial approach. Results: In group A, range of motion was graded as excellent in 71.43%, good 21.43%, and fair 7.14%. In group B, the range of motion was excellent in 70%, good 20%, and fair 10%. Deformity was observed in one patient (10%). In group C the range of motion of the elbow was excellent in 66.6%, good 16.7%, and fair 16.7%. Deformity was seen in two (16.7%) patients. Pin tract infection was seen in one patient in each group. Conclusion: In surgical treatment of humeral supracondylar fracture with normal neurovascular state in children, due to its simplicity, greater exposure, lack of interference with vital structures, and better surgical outcome, the posterior approach particularly posterior triceps splitting method is advocated.

The comparative study of the clinical effect for different surgical approach to treat children with supracondylar fractures

Objective To investigate the clinical effect of tongue-shaped flap cut into the triceps and triceps both sides of the road approach road into the way of two surgical treatments of supracondylar fractures in children.Methods 90 patients with pediatric supracondylar fractures were chosen.50 cases of tongue-shaped flap to triceps road cut into were set as A group,40 patients taking brachial three muscles on both sides of the first approach were set as the B group.The clinical effects of the two groups were compared.Results The operative time,blood loss,cast immobilization time in B group was superior to group A ( P ＜ 0.05 ),there was statistically different.The pain score improvement in group B was significantly better than group A before and after treatment(P ＜0.05),the difference was statistically significant.After treatment,A group of patients with excellent results was in 22 cases,good in 24 cases,the fine rate was 92％.B group with excellent results was in 23 cases,good was in 16 cases,the good rate was 97.5％.The superior quality of the treatment effect in B group was better than A group( P ＜ 0.05),the difference was statistically significant.Conclusion The operative time,blood loss,time cast immobilization,pain improvement,the treatment effects for triceps both sides of the approach for the treatment of supracondylar fractures in children are better than the triceps tongue-shaped flap cut into the road,and there is high clinical value. Key words: Children; Fractures, bone; Surgical procedures, Operation

Treatment of Gartland type III humeral supracondylar fractures in children through anterior traverse approach

Objective To investigate the clinical effects of minimally invasive incision in anterior traverse approach for Gartland type Ⅲ humeral supracondylar fractures in children. Methods Forty-two patients with Gartland type Ⅲ displaced supracondylar fractures of the humerus were treated through anterior traverse approach between January 2008 and April 2011.The fractures were fixed using two Kirschner wires from the medial and lateral epicondyles placed crossing each other.There were 31 males and 11 females,at age of 2.6-12 years (average 5.7 years).Three patients were with open fractures.Seven patients were combined with other fractures,four with radial nerve injury and one with median nerve injury,with time from injury to hospitalization for a range of 1 hour to 3 days.Of all the patients,30 patients were with fractures on the right side and 12 with fractures on the left side.All fractures were treated by minimally invasive incision in anterior traverse approach,when the neurovascular and muscular probing and repair were performed. Results Forty patients were followed up for 3-32 months ( average 13 months),which showed incision healing at one stage,with fracture healing time for 3-4 weeks (average 3.6 weeks).No cubitus varus or incision scar were found after operation.According to Flynn' s criteria,the effect of treatment three months after operation were excellent in 32 patients,good in four and fair in four,with excellence rate of 90％. Conclusions The minimally invasive incision of anterior traverse approach is characterized by minor trauma,small incision,nil scar and convenient neurovascular and muscular exploration and hence is a safe and reliable treatment for open reduction of Gartland type Ⅲ humeral supracondylar fractures in children. Key words: Humerus ; Fracture fixation, internal; Child

A retrospective analysis of loss of reduction in operated supracondylar humerus fractures

Background:Loss of reduction following closed or open reduction of displaced supracondylar fractures of the humerus in children varies widely and is considered dependent on stability of the fracture pattern, Gartland type, number and configuration of pins for fixation, technical errors, adequacy of initial reduction, and timing of the surgery. This study was aimed to evaluate the factors responsible for failure of reduction in operated pediatric supracondylar fracture humerus.Materials and Methods:We retrospectively assessed loss of reduction by evaluating changes in Baumann's angle, change in lateral rotation percentage, and anterior humeral line in 77 consecutive children who were treated with multiple Kirschner wire fixation and were available for followup. The intraoperative radiographs were compared with those taken immediately after surgery and 3 weeks postoperatively. Multivariate logistic regression analysis was performed by STATA 10.Results:Reduction was lost in 18.2% of the patients. Technical errors were significantly higher in those who lost reduction (P = 0.001; Odds Ratio: 57.63). Lateral pins had a significantly higher risk of losing reduction than cross pins (P = 0.029; Odds Ratio: 7.73). Other factors including stability of fracture configuration were not significantly different in the two groups.Conclusions:The stability of fracture fixation in supracondylar fractures in children is dependent on a technically good pinning. Cross pinning provides a more stable fixation than lateral entry pins. Fracture pattern and accuracy of reduction were not important factors in determining the stability of fixation.

Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

Background and purpose Ulnar nerve injury may occur after pinning of supracondylar fractures in children. We describe the outcome and compare the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing.Methods Medical charts of all children sustaining this fracture treated at our department between 1994 and 2009 were retrospectively reviewed regarding the mode of treatment, demographic data including age and sex, the time until implant removal, the outcome, and the rate of ulnar nerve injuries.Results 503 children (55% boys) with an average age of 6.5 years sustained a type-II, type-III, or type-IV supracondylar fracture. Of those, 440 children were included in the study. Antegrade nailing was performed in 264 (60%) of the children, and the others were treated with crossed pins. Iatrogenic ulnar nerve injury occurred in 0.4% of the children treated with antegrade nailing and in 15% of the children treated with crossed pinning. After median 3 (1.6–12) years of follow-up, the clinical outcome was good and similar between the 2 groups.Interpretation Intramedullary antegrade nailing of displaced supracondylar humeral fractures can be considered an adequate and safe alternative to the widely performed crossed K-wire fixation. The risk of iatrogenic nerve injury after antegrade nailing is small compared to that after crossed pinning.

Castries Prone Positioning for Open Reduction and Internal Fixation of Closed Gartland Grade III Humeral Supracondylar Fractures in Children

Pediatric humeral supracondylar fracture Gartland type III is an orthopedic emergency that requires hospitalization and surgical treatment. This is a prospective study to document a simple positioning of the patient for easy reduction. Patients with Gartland type III humeral supracondylar fracture below the age of 12 years were recruited for this study after x-ray and classification. The patients were admitted to the ward from the emergency room after stabilization and subsequently had open reduction and internal fixation with Kirschner wire crossing in prone position. Twenty patients with Gartland type III humeral supracondylar fractures constituted the study group. There were 15 male and 5 female patients with Male:Female ratio of 3:1. The age ranged between 1 and 12 years with average of 6.1±3 years. The left humerus was affected 14 times compared with 6 times for the right humerus. We found out that the prone positioning is simple and does not require an assistant to constantly hold the forearm in position as would be required when the patient is placed in supine position. The prone positioning technique would be useful to fix humeral supracondylar fractures with Kirschner wire fixation where there is no radiologic aid for percutaneous pinning.

Biomechanical analysis of percutaneous all lateral pinning (Dorgan's technique) technique for supracondylar humerus fractures in children

We tried to compare biomechanical properties of all lateral pinning (Dorgan's technique) with other pinning configurations used for humerus supracondylar fractures in children. In all lateral pinning technique iatrogenic nerve injury risk is minimized with secure fixation compared with other pin fixation configurations. Biomechanical testing was performed on 50 synthetic humeral bones (Keklikoglu). Transverse supracondylar humeral fractures were made with a hand-held saw above the olecranon fossa. Five different pin configurations were selected for fracture stabilization: 2 lateral pins and 1 medial pin (3 crossed), 2 laterally divergent pins, 2 crossed pins, 2 all laterally crossed pins (Dorgan's technique), 2 laterally parallel pins. All the pin configurations were fluoroscopically confirmed. The fractures were stabilized with 0.062″ Kirschner wires. Biomechanical tests were performed by torsional load producing machine with internal rotation of the distal fragment. All the models were subjected to torsional loads for 10 times between 5 and 50 N and rotation in degrees and corresponding torques were recorded for statistical analysis. The differences of the stiffness of the pin configurations [2 lateral pins and 1 medial pin (3 crossed), 2 laterally divergent pins, 2 crossed pins, 2 all lateral crossed pins (Dorgan's technique), 2 laterally parallel pins] were found, respectively, 0.06, 0.043, 0.039, 0.012 and 0.013 N m/degree. All lateral crossed pins (Dorgan's technique) showed biomechanically equal properties to the medio-lateral, lower to the 2 lateral and 1 medial pin, and superior to the other pin configurations. All lateral crossed pins do not jeopardize the ulnar nerve during insertion of the pins percutaneously and fix the fracture with low learning curve.

Pitfalls of lateral external fixation for supracondylar humeral fractures in children.

Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. All supracondylar fractures treated with lateral external fixation between 2005 and 2007 were evaluated retrospectively. Long-term outcome was assessed with regards to carrying angle, malalignment, and motion. Twenty-eight patients with Gartland type III fractures and one with a Y-type fracture were included in the study (mean age 6.5years). Cosmetic results were excellent in 88%, good in 8%, and fair in one patient. Functional results were excellent in 83%, good in 10%, and fair in 7%. However, 3 patients (10%) showed complete radial palsy postoperatively. In all of these patients, high insertion of the proximal pin (2.9-3.6cm above the fracture) was noted. On revision, one superficial lesion and one total transection of the nerve at the level of the proximal pin was detected. One patient showed no macroscopic damage. The transected nerve was reconstructed using an autograft, and all patients completely recovered within 2-6months. Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2cm from the fracture line using a drill sleeve.

Medial and Lateral Pin Versus Lateral-Entry Pin Fixation for Type 3 Supracondylar Fractures in Children

The purpose of this study is to compare the efficacy of medial and lateral (crossed pin) and lateral-entry pin techniques for Gartland Type 3 supracondylar humerus fractures in children. Six pediatric orthopaedists were divided into the 2 treatment groups (medial and lateral pins or lateral only pins) based on pre-study pinning technique preferences. Patients were randomized into 1 of the 2 pinning technique treatment groups based on which attending was on call at the time of patient presentation. One hundred and four patients met inclusion criteria. Forty-seven patients underwent lateral-entry pinning and 57 underwent crossed pinning. The 2 groups were similar with respect to age, sex, preoperative neurovascular injury, direction of fracture displacement, and timing of surgery. Outcome parameters measured included radiographic maintenance of reduction, iatrogenic neurovascular complications, and rate of infection. All radiographic measurements, and interobserver reliability, were determined by a 3 physician panel. The results of the interobserver reliability data showed a strong correlation and this data allowed 95% confidence that a change in Baumann's angle of more than 6 degrees and humerocapitellar angle of more than 10 degrees was significant. The lateral-entry patients experienced a median absolute change of Baumann's angle of 3.7 degrees with 12 patients having greater than 6 degrees loss of reduction; whereas those in the medial and lateral-pin group saw a median change of 2.9 degrees with 10 patients having greater than 6 degrees loss of reduction. In terms of the humerocapitellar angle, the lateral-entry patients experienced a median absolute change of 4.8 degrees with 11 patients having greater than 10 degrees loss of reduction; whereas those in the medial and lateral-pin groups saw a median change of 5.1 degrees with 17 patients having greater than 10 degrees loss of reduction. There was no significant difference in infection rate between the 2 groups but 2 cases of iatrogenic neurovascular injury occurred in patients who had a medial pin placed. We found no statistical difference in the radiographic outcomes between lateral-entry and medial and lateral-pin techniques for the management of Type 3 supracondylar fractures in children when evaluated in this prospective and surgeon-randomized trial, but 2 cases of iatrogenic injury to the ulnar nerve occurred with medially placed pins. Level 2.

Pediatric supracondylar fractures of the humerus Medial-lateral crossed pinning versus lateral pinning alone (UPDATE to December 2007 report)

Evidence from three small randomized controlled trials indicates that medial-lateral crossed pinning and lateral pinning for fixation of supracondylar fractures in children may be comparable. Overall, no differences were found between the treatment groups regarding mean Baumann-angle loss, carrying angle loss, range of motion,risk of poor outcome, iatrogenic nerve injury, and infection. Infection (two studies) and ulnar nerve injury (one study) were more common in the medial-lateral treatment group, but the difference was not significant.Additional randomized trials with larger sample sizes and longer follow-up are necessary to establish the long-term safety and efficacy of these two operative treatments. 3项小样本随机对照研究显示内外侧交叉克氏针固定与外侧克氏针固定治疗儿童肱骨髁上骨折疗效相当.根据总体研究结果分析,两治疗组间Baumann角和提携角的丢失、关节活动度、功能障碍、医源性神经损伤及感染的发生率等监测指标差异均无统计学意义.虽然感染(其中2项研究)和尺神经损伤(其中1项研究)在内外侧克氏针固定组更为常见,但是差异并无统计学意义.因此,为明确两种治疗方法的远期有效性和安全性,还需开展大样本随机对照研究,并进一步增加病例的随访时间.……