Supracondylar Fractures Of The Humerus Research Articles

METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation configurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct.

Pediatric orthopedic surgeons may perform better in terms of surgical outcomes in type 3 supracondylar humerus fractures: a comparative analysis

Supracondylar fractures of the humerus represent the most common surgical fractures in pediatric patients. There is a discourse regarding the influence of the surgeon training on treatment. Different studies show equivocal effect of subspecialty training. We conducted a single center case control study to evaluate the outcomes of type 3 fractures (fully displaced) comparing pediatric-trained orthopedic surgeons (PTOS) and non-pediatric trained orthopedic surgeons (NTOS). In this retrospective study, we investigated the surgical outcomes of type 3 supracondylar fractures of the humerus in children treated between the years 2012 and 2019, divided by surgeon type. During the research, a policy reform at our department was established and PTOS became the only surgeons for those injuries starting from September 2017. Patients’ demographics, perioperative details, and postoperative course were recorded. Primary outcome was reoperations, and secondary outcomes were open reductions, infections, length of surgery, and neurological deficits. 1175 patients were diagnosed with supracondylar fractures at our Level I trauma center, and 346 cases were diagnosed with radiologically confirmed type 3. Overall, 312 cases were analyzed; 113 cases were diagnosed before 1 September 2017 and treated by NTOS, and 199 cases were treated by PTOS until 31 December 2019; 7.1% (8) of the patients treated by NTOS had to be reoperated compared to 1.5% (3) of the patients treated by PTOS (P = 0.014). There was significant difference looking at postsurgical complications and surgery length. This study’s findings suggest that PTOS achieve superior outcomes when treating patients with type 3 supracondylar humerus fractures. Level of evidence: Level III.

Comprehensive Assessment of Injuries in Patients with Supracondylar Fractures of the Humerus in Childhood and Adolescence

Comprehensive Assessment of Injuries in Patients with Supracondylar Fractures of the Humerus in Childhood and Adolescence

A Comparison of Nerve Injury in Cross Versus Lateral Pinning Fixation of Displaced Supracondylar Humerus Fracture.

Supracondylar fracture of the humerus (SCFH) is a common pediatric fracture encountered in orthopedic surgery. The most frequently used pinning methods include cross pinning or lateral pinning with two or three pins. However, complications such as ulnar nerve injury can occur, particularly during medial pinning, which necessitates careful isolation of the ulnar nerve and expert surgical intervention. The objective of this study is to compare nerve injury in cross versus lateral pinning fixation of the SCFH. The observational study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, PAK. Patients in group L (n=55) underwent lateral pinning, while those in group C (n=55) received cross pinning. The patients were followed retrospectively postoperatively until radiological union was achieved. The outcomes were assessed using the Flynn criteria, and nerve injury was evaluated in both groups. The study aimed to compare the postoperative results between the two groups based on the specified criteria. The mean age was 7.28±2.03 years in group L and 8.20±2.21 years in group C. The majority of patients in both groups were male. The left side was more commonly involved, and among the 110 patients enrolled, most sustained the injury while playing. The mean follow-up period was 21.3±1.4 months for group L and 23.5±0.2 weeks for group C. Nerve injuries were reported in six (5.45%) patients in group C, while no nerve injuries were reported in group L. For type III SCFH, lateral pinning fixation has demonstrated itself to be an effective alternative, yielding excellent functional outcomes. This method not only minimizes the risk of iatrogenic nerve injury, particularly to the ulnar nerve but also provides sufficient stability for the fracture. The results from this study suggest that lateral pinning is a reliable option for treating unstable supracondylar fractures, with a favorable safety profile and outcomes comparable to, if not better than, those achieved with cross pinning. This makes it a valuable technique, especially in settings where the risk of nerve injury is a significant concern.

Management of cubitus varus deformity by three-dimensional osteotomy: analysis of outcome

Background: Cubitus varus deformity, commonly resulting from malunited supracondylar fractures of the humerus, is prevalent in pediatric and adolescent populations. Traditional treatment methods often fall short in addressing the complex three-dimensional nature of this deformity. This study aims to evaluate the efficacy and outcomes of three-dimensional osteotomy in correcting cubitus varus deformity. Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery, BSMMU, Shahbag, Dhaka, from March 2016 to September 2018. A total of 40 patients aged 8 to 20 years with cubitus varus deformity were enrolled. Participants underwent three-dimensional osteotomy, and outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and functional recovery parameters. Results: The majority of patients (75%) achieved bone union within 8-10 weeks post-osteotomy. The MEPS results were promising, with 40% of patients scoring 'Excellent' and 45% scoring 'Good'. Functional outcomes were predominantly positive, with 95% of patients reporting satisfactory results. The complication rate was low, with 80% of patients experiencing no postoperative complications. Conclusions: Three-dimensional osteotomy is an effective and reliable surgical intervention for treating cubitus varus deformity, offering high rates of patient satisfaction, minimal complications, and improved functional outcomes. This technique presents a promising option for orthopedic surgeons in managing this complex deformity.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report

BackgroundDue to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.Case presentationA 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.ConclusionIn this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Minimally invasive techniques utilizing the “Joy Stick” method for managing irreducible flexion-type supracondylar fractures of the humerus in older children

ObjectiveIn this study, we investigated the efficacy of percutaneous poking reduction and Kirschner wire fixation in older children with irreducible supracondylar flexion-type fractures of the humerus.MethodsThis retrospective investigation included 27 children, comprising 15 males and 12 females, aged between 10 years and 3 months to 14 years and 11 months, all diagnosed with a flexion-type supracondylar fracture of the humerus within one week of trauma. All patients underwent surgery under general anesthesia. Following unsuccessful manual reduction, percutaneous poking reduction with Kirschner wires was performed under C-arm fluoroscopy to achieve fracture reduction. Following successful reduction, three 2.0 mm Kirschner wires were inserted in a cross pattern to secure the fracture ends. Postoperatively, the elbow joint was immobilized in a functional position with a plaster cast for four weeks.ResultsFollow-up in the outpatient department ranged from 9 to 36 months. Clinical functional assessment using Flynn’s criteria rated 24 cases as excellent, 2 as good, and 1 as fair, yielding an overall efficacy of 96.3%. No cases of fracture re-displacement, fracture fragment necrosis, or other complications such as nonunion, iatrogenic nerve injury, myositis ossificans, or long-term elbow joint dysfunction were observed during the postoperative follow-up.ConclusionThe percutaneous poking reduction and Kirschner wire fixation technique is a simple and reliable procedure for treating irreducible flexion-type supracondylar fractures of the humerus in older children, with minimal trauma. This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function.

Closed Reduction and Percutaneous Cross K-wire Fixation: Management of Displaced Supracondylar Fracture of the Humerus (Gartland Type-III) in Children

Introduction: Supracondylar fractures of the distal humerus, occurring just above the elbow joint, are the most common pediatric fractures around the elbow, accounting for 60-70% of all elbow injuries in children. Methods: This prospective observational study, conducted from June 2023 to May 2024 at NITOR, Dhaka, Bangladesh, focuses on managing displaced supracondylar fractures (Gartland Type-III) in children. Result: The average age of the patients in the study is reported as 6.5 years. The number and percentage of male and female patients are presented, with a total of 17 males (56.7%) and 13 females (43.3%) respectively. The average time for radiographic healing of the fractures was 5.2 weeks. Satisfactory radiographic outcomes were observed in 28 patients (93.3%), indicating favorable radiographic evidence of fracture healing and alignment. K-wires were typically removed around the 1-month mark postoperatively, once radiographic healing was confirmed and satisfactory outcomes were achieved. Conclusion: In conclusion, our study supports the efficacy and safety of closed reduction and percutaneous cross K-wire fixation for treating displaced supracondylar fractures of the humerus in children.

Compartment Syndrome of the Lower Limb in Adults and Children and Effective Surgical Intervention and Post-surgical Therapies: A Narrative Review.

Compartment syndrome (CS) can be defined as an acutely painful condition that occurs due to increased pressure within a compartment, resulting in reduced blood flow and oxygen to nerves and muscles within the limb. It is considered a surgical emergency, and a delayed diagnosis may result in ischemia and eventual necrosis of the limb. The majority of cases in adults are associated with high-energy trauma, more specifically, long bone fractures of the lower limb, while supracondylar fractures of the humerus are highly associated with CS in pediatric patients. CS may also develop gradually as a result of prolonged and ongoing physical activity such as running. In this narrative review, we discuss the anatomy, pathophysiology, methods of diagnosis, and effective management of CS in adults and children.

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.

Epidemiology of Paediatric Fractures at Koshi Hospital, A Tertiary Center in Eastern Nepal

Introduction: Paediatric trauma is a leading cause of disability, hospitalization and may lead to mortality in pediatric population. Incidence and nature of fracture varies according to region, culture, seasonal variations and age. Children are more prone to have injury at play grounds, due to fall from height and also due to road traffic accident due to unmanaged traffic and lack of road safety measures. Identification of specific high-risk injury patterns may lead to improved care and outcome. This study aims to find out the epidemiological profile of paediatric injuries presenting to a tertiary care hospital in eastern Nepal. Objective: To study the common fractures and their management in the paediatric age group at Koshi hospital. Methodology: This was a hospital based retrospective cross-sectional study done among 424 paediatric patients at Koshi hospital from January 2021 to December 2021.Ethical clearance was taken from Nepal health research council . Data collection was done from the outpatient (OPD), emergency and the operation room records and was compiled in Microsoft excel 2007. Results: A total of 424 paediatric fractures were taken into study over the duration of one year. Out of which 288 were male (67.92%) and 136(32.08%) were female. Playground injuries were the most common cause of paediatric fractures (49.76%) followed by fall from height (27.35%) and road traffic accident (12.26%). Distal radius and ulna fracture was found to be most common (30.89%). Conclusion: Distal radius and ulna is the commonly fractured bone followed by supracondylar fractures of the humerus. Most of the paediatric fractures can be managed conservatively. Supervised play in the grounds, at home and at schools are important because paediatric injuries most of the times can be prevented to decrease the morbidity and mortality in the paediatric population. Proper knowledge and awareness of the traffic rules and zebra crossings should be implemented with local community participation and cooperation.

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.

Fracturas Supracondíleas Humerales Pediátricas. Comparación de dos Técnicas de Reducción

Objective: To analyze the results of the surgical technique placement of Kirschner pins lateral versus crossed in the management of supracondylar fractures of the humerus in pediatric patients. Methodology: All pediatric patients with humeral supracondylar fracture who required surgical intervention and were subsequently evaluated 24 hours and 6 months after surgical treatment to observe and compare the differences between each patient. surgical technique used. Taking into account the acute and late complications that occurred, through an analysis with the Mann-Whitney test. Results: For the present studies, 44 pediatric patients were evaluated, of whom 70% were men and 30% women, in whom nerve and angular complications presented without any significant importance with the sex and age of the patients, with ulnar nerve involvement being the most frequent with 33% in cross placement. When carrying out the comparison with discrimination of variables, it is obtained that the placement laterally presents fewer early and late post-surgical complications and that such are not due to chance. Or the present study, it is considered that a placement of Kirschner pins laterally regardless of the member, age, gender or classification; leads to better post-surgical results. Limitations or implications: In the present study, the type of mechanical damage that causes this type of fracture was not included, nor was the Baumann angle considered. Another limitation inherent in the pediatric population is the ability of the examiner to detect a neurological deficit, especially in young patients since reports of a physical examination are always subjective. Furthermore, given the limited details of the specific damage mechanism, the number of damages caused by high-energy mechanisms may be underestimated. Originality or value: Its importance lies in the fact that both surgical techniques were performed by the same surgeons and that it is a study in the mexican population, being a contribution to the literature of this country. Findings or conclusions: Both surgical techniques present post-surgical results with cases of nerve injury, angular deformity, pain and persistent edema, but the one that presents them less frequently in the technique of placement of Kirschner pins laterally, in addition to causing statistical significance in terms of the decrease of presenting cubitus valgus in the late follow-up of the patients.