Supracondylar Fractures Of The Humerus Research Articles

A comparative study of functional outcome of criss-cross pinning vs parallel pinning for Gartland type III supracondylar humeral fractures in children in tertiary care centre

Introduction: Supracondylar fracture of the humerus is the most frequently encountered elbow injuries among children that occupies around 60% of all elbow injuries in the initial ten years of life. Trouble in reduction and its maintenance, recurrent association of neurovascular structures injury are the common complications of displaced supracondylar fractures.Methods: Around 64 patients with displaced type III supracondylar fractures of humerus were selected who fulfilled our inclusion criteria. The method of patient selection for criss-cross pinning (GROUP-1) or parallel pinning (GROUP-2) be random. All the children with suspected supracondylar fractures of the humerus were assessed for vascular and neurological status. Clinical evaluation was graded according to carrying angle and elbow range of motion using the criteria of Flynn. Radiographic evaluation was performed at 3rd week, 6 week and at 3 and 6 months. In the 3rd week, the pins were removed. At 3- and 6-month follow-up, the children were evaluated for full function, minor limitation of function and major loss of function. Result: All the 64 subjects in our study had full range of motion postoperatively. The carrying angle in group 1 Vs group 2 was 11.18±1.99 Vs 11.96±1.92. The Baumann’s angle in group 1 Vs group 2 was 71.59±3.10 Vs 71.65±2.23. Flynn et al. in group 2 with parallel all the 100% had excellent score whereas in group 1, 94% had excellent Conclusion: From our study, we concluded that the lateral pinning technique provides better functional outcome as cross pinning technique in the management of displaced supracondylar fracture of humerus in children. When compared to crossed wire pinning, lateral pinning avoids the risk of nerve injury, reduces operation time and have Flynn excellent scores.

Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study

Abstract Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration (p < 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, p < 0.038) as well as ORIF (odds ratio = 26.2, p < 0.001). Conclusion Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. Level of Evidence Prognostic III.

Transolecranon and lateral Kirschner wire fixation for displaced supracondylar humeral fracture in children

Abstract Introduction Percutaneous pinning of supracondylar humerus fracture(SCHF) in children is an effective way to maintain the anatomic reduction of a displaced. closed reduction and percutaneous pinning (CRPP) had been considered the standard treatment for displaced SCHF in children. Patients and methods A prospective case series, was conducted at the emergency department of Helwan university hospital from February 2020 to September 2021. It includes 40 patients with Gartland type III fracture who presented to the orthopaedic casualty and were included in the study. Four patients (10%) had the transolecranon wire was directed intramedullary, 11 patients (27%) had the wire directed posterolaterally, and 16 patients (40%) had the wire directed posteromedially and 9 patients (23%) had the wire directed posteriorly. Results The mean age was 5.57 years (range from 2–12 years). The mean Baumann angle in the patients was (70.89 ± 2.40). The mean follow-up duration was 3 months (range from 3–3.2 months). with mean carrying angle was about (9.37 ± 2.52) and no one of the patients had an excessive deformity of carrying angle that required correction. Regarding ROM loss, there were 25, but always poor. A few complications occurred including pin tract infection and broken transolecranon wire and all were tolerable with no effect on the outcome. Conclusion The Transolecranon and lateral Kirschner wires fixation is an effective option that provides good stability with the little number of trials in the management of supracondylar fracture of the humerus in children, and the risk of nerve injury or fishtail deformity was avoided especially in the hands of junior trainees in their first 3 years of training.

Clinical efficacy of closed reduction combined with percutaneous cross Kirschner wire fixation for the treatment of supracondylar fractures of the humerus in children

Clinical efficacy of closed reduction combined with percutaneous cross Kirschner wire fixation for the treatment of supracondylar fractures of the humerus in children

Effects of eyeshades in sleep quality and pain after surgery in school-age children with supracondylar humeral fractures.

This study aimed to explore the effects of eye masks on the sleep quality and pain of children over 5 years old with humeral supracondylar fracture after surgery. Fifty children with humeral supracondylar fracture who underwent closed reduction and percutaneous pinning (CRPP) in the Pediatric orthopaedic Department of a provincial hospital in China from February 2020 to December 2021 were selected. The children were randomly divided into the experimental group (n = 25) and the control group (n = 25). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights after surgery. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children's Pain Behaviour Scale was used to evaluate the pain of the children. After three nights of receiving the eye mask intervention, the children in the experimental group had significantly lower sleep quality scores than those in the control group; the difference was statistically significant (p < 0.05), and the children in the experimental group had higher sleep quality. The experimental group's pain scores were significantly lower than the control group's, and the difference was statistically significant (p < 0.05), and the children in the experimental group experienced less post-operative pain. Eye masks are a simple, safe and economical intervention, that is beneficial for improving the sleep quality and reducing pain in children over 5 years old with humeral supracondylar fracture after closed reduction and percutaneous pinning. It can be used as a reference and basis for clinical pain relief and sleep quality after surgery for supracondylar fractures of the humerus in children.

Supracondylar fracture humerus with pink pulseless hand and angiogram confirmed vascular injury – Case report

Supracondylar fracture of the humerus is a common injury in paediatric population. Neurovascular damage is a well-known serious complication of this injury. This should be managed urgently by the treating clinician in order to prevent severe disability to the child. In this case report, we illustrate the presentation, management and follow up of a 7-year-old boy presented with a supracondylar humerus fracture, highlighting the diagnostic and therapeutic measures taken in sequential manner.&#x0D; The child presented following a domestic fall and having pain, swelling and acute deformity of the left elbow. Clinically, no distal radial pulse or oxygen saturation using pulse oximetry detected on admission, even though the left hand was warm and pink with normal capillary refill time. X-ray confirmed the clinical diagnosis of supracondylar fracture humerus, and it was classified as Gartland type III.&#x0D; Manipulation and casting done without internal fixation on the next available casualty list and even after 72 hours of the procedure no return of distal pulse despite warm, pink hand. After vascular opinion, CT Angiogram revealed no flow segment of 2.2cm of brachial artery at the trauma site and minimum demonstrable flow distally. However, watchful waiting was selected as the management option by both vascular and orthopaedic teams as this child continues to have warm, pink hand with normal capillary refilling and minimal pain.&#x0D; In 6 months follow up, the child has gained both radial and ulnar pulses, full range of elbow motion, complete neurological recovery and good hand function.

The outcome of displaced pediatric supracondylar fractures of the elbow treated with lateral three divergent K wires

Introduction: Supracondylar fracture of the humerus is the commonest elbow injury in children, treated with closed reduction and percutaneous fixation. Crossed K-wires fixation is more biomechanically stable than lateral K – wires only. Recent biomechanical studies have shown that 3 lateral divergent K—wire fixation is as stable as cross K-wire fixation. Furthermore, lateral divergent fixation is associated with a good clinical outcome. Methods: A descriptive cross-sectional study was conducted in the department of orthopedics at People’s General Hospital, Kathmandu between the period of January 2018 to December 2020. Medical records of 76 supracondylar fractures of humerus Gartland type III and IV were reviewed out of which 46 patients were included in the study after meeting the inclusion criteria. Radiological assessment was done to assess fracture union and stability. Flynn's grading system was used for functional outcomes. Results: The mean age was 7.3 years (range 4 – 13 years). The boys were 32 (70%) and girls were 14 (30%). The follow-up was 9.2 months (range 3 – 12 months). At the final follow-up, the mean range of elbow motion at final follow up was 0.86 ± 4.58° - 135.86 ± 4.078°, the mean arc of motion was 139.9 ± 6.2°, and the mean carrying angle was 13.63± 32.15°. No iatrogenic ulnar nerve injury was noted. Five patients (10.8%) had superficial pin site infection, managed with local dressings after pin removal. According to Flynn’s grading system, 41 patients (89.1%) achieved excellent results, and one patient had poor results. None of them had chronic discharge after the wire removal. Conclusion: Closed reduction and percutaneous 3 lateral divergent K – wire fixation for type III and IV supracondylar fracture of humerus in children provides a stable configuration with good functional outcomes and avoids iatrogenic ulnar nerve injury.

Neural wedge osteotomy method of correction for cubitus varus deformity in children.

In this study, we evaluated the clinical outcome of neutral wedge osteotomy assisted with the center of rotation of angulation (CORA) method of distal humerus anatomical axis for the treatment of cubitus varus deformity in children. From 2016 to 2019, 20 children with cubitus varus deformity after supracondylar fracture of the humerus were enrolled. Standard anteroposterior radiograph of the humerus was taken preoperatively. The CORA point and angulation angles were obtained by measuring the proximal and distal humerus anatomical axis. During the operation, neutral wedge osteotomy was performed to correct the varus deformity. The Baumann angle and the carrying angle were used to evaluate the correction effect of the distal humeral varus deformity. The average age of the patients was 7.8 years. Patients were followed up for an average of 29.3 months (range, 24–36 months). The average interval between surgery and injury was 12 months. The mean preoperative Baumann angle and carrying angle were 99° (90°–115°) and –14° (range, –10° to –30°), respectively. At the last follow-up, the mean Baumann angle and carrying angle was 76° (70°–80°) and 13.6° (10°–18°), respectively, with 16 cases showing excellent outcome and 4 cases showing good outcome. Our results indicated that the neutral wedge osteotomy assisted with CORA method of distal humerus anatomical axis showed good clinical outcomes in the treatment of cubitus varus deformity in children and is worthy of clinical application. The level of evidence is IV.

Comparative Study of the Functional Outcome of Elbow Joint in Supracondylar Fractures of Children Treated With k Wire Fixation Using Lateral and Posterior Approaches

Introduction: Supracondylar fractures of the humerus are the most common elbow fracture reported in children. When closed reduction fails, open reduction and pinning will be used as a definitive procedure. In this study, we compare the functional outcome of lateral and posterior approaches of open reduction and assess the range of elbow movements and carrying angle by using Flynn's criteria.Methods: This is a prospective study conducted on 30 children with supracondylar fracture of the humerus in Adichunchanagiri Hospital from a period of December 2018 to August 2020. A total of 30 children were selected for this study. Fifteen children underwent open reduction and pinning using the lateral approach (group 1) and 15 children underwent open reduction and pinning using the posterior approach (group 2) and all were followed up for six months. Functional outcome was assessed at the end of six months using Flynn's criteria.Results: There were 20 boys and 10 girls in the study group. The mean age was 9.43 ± 1.69 years. The majority of children sustained injury due to falls on an outstretched hand (80%). One case of pin tract infection occurred in both the study groups. One patient had a superficial infection (6.7%) with the lateral approach, whereas two patients had a superficial infection with the posterior approach (13.33%). The lateral group fared better than the posterior group in comparison using Flynn criteria.Conclusion: Lateral approach might be better than the posterior approach for unreduced supracondylar fractures necessitating open reduction and k wire fixation.

EVALUATION OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES TREATED WITH CRISSCROSS VS LATERAL PINNING

Introduction : Supracondylar humerus fractures are the most common elbow fractures seen in children. The peak age is 5 to 6 years .Gartland classified these fractures in to extension and flexion type with former being most common. Extension injuries are further divided in to un displaced (type 1),partially displaced with intact posterior cortex(type 2),completely displaced (type 3).Type 2 and type 3 fractures requires intervention (closed reduction and pinning). In this scenario, our study is designed to know the functional outcome of Criss cross pinning versus lateral pinning in supracondylar humerus fractures Aim : 1. To restore the anatomy of the distal end of the humerus with percutaneous Kirschner's wire fixation. 2. To evaluate the functional and cosmetic outcome of displaced supracondylar fractures of the humerus in children treated with cross pinning and lateral pinning. Materials And Methods : A prospective study with 30 cases of Gartland type 2 and type 3 supracondylar fracture humerus, treated by lateral ( n=16 ) and criss cross ( n=14 ) pinning, was conducted between October 2018 to october 2020. The results were expressed as mean and standard deviation and p&lt;0.05 was considered as statistically significant. Results : In this study, among thirty patients, cross pinning was done in fourteen patients (46.67%), and lateral pinning was done in sixteen patients (53.33%). All patients had satisfactory results according to Flynn's criteria.Conclusion : There was no significant difference in cosmetic outcome, i.e. loss of carrying angle, and in functional outcome i.e.; loss of flexion in degrees between crisscross Kirschner wire fixation and lateral Kirschner wire fixation in supracondylar fractures of the humerus in children.

Learning Curve of Closed Reduction and Internal Fixation for Supracondylar Fractures of the Humerus in Children

BackgroundThis study aimed to identify the threshold for success in supracondylar humeral fracture surgery by describing the learning curve for beginners and exploring the relationship between the learning curve and the prognosis of supracondylar fractures of the humerus.MethodsSurgical information was collected of the first 100 humeral fractures treated by four pediatric orthopedic surgeons. The relationship between operation time, wire placement success rate, and surgical experience was determined using the restricted cubic strip (RCS). The inflection point in the curve and other risk factors that may affect fracture prognosis were collected and subjected to multiple logistic regression to clarify the relationship between the learning curve and prognosis of supracondylar fractures of the humerus. After the training, the four fresh surgeons were interviewed in the form of questionnaires to get feedback from the trainees.ResultsA total of 400 supracondylar fractures of the humerus from four pediatric orthopedists were included in the study. On an RCS analysis, 65 surgical experiences were the inflection point of the learning curve. Before and after these 65 surgical experiences, there were significant differences in the patients' anatomical reduction (186 vs. 122, P < 0.001), conversion to incision (33 vs. 6, P = 0.008), and supervising physician guidance (28 vs. 2, P < 0.001). In the multiple logistic regression analysis, functional recovery after supracondylar fractures of the humerus was significantly associated with surgical experience, intraoperative conversion to incision, and post-operative infection. Four surgeons and a supervisor were interviewed. They believed that self-confidence establishment requires the experience accumulation of about 30 operations. The most critical surgical technique is the reduction of fractures.ConclusionsAlthough the accumulated experience of 30 operations can establish the self-confidence of trainers, fresh surgeons must accumulate experience with 65 operations to master closed reduction and internal fixation for supracondylar fractures. Surgical experience significantly impacts the post-operative recovery of patients with fractures.Level of EvidenceLevel III.

Short-Term Management Outcomes of Supracondylar Fractures of the Humerus and Their Associated Factors in Children Managed at Mulago National Referral Hospital.

PurposeSupracondylar fractures (SCF) of the humerus is one of the commonest global health concerns among children and need a rigorous management process to obtain satisfactory outcomes. It is of paramount importance to use systematic guidelines to aid abate bad fracture outcomes. The study primarily sought to determine the functional and radiological management outcomes of SCF of the humerus in children at Mulago National Referral Hospital (MNRH) and associated factors to the outcomes.MethodsWe conducted a hospital-based, cross-sectional study among children managed for SCF of the humerus at MNRH. Using Flynn’s criteria, current flexion and extension at the elbow joints, humeroulnar angle and the neurology were assessed and compared to the contralateral limb to get the functional outcomes. The pre-management digital radiographs of the elbow joint were compared with the current radiographs to assess radiological outcomes. Bivariate and multivariate analyses were used to determine the associated factors.ResultsOf the 77 children, 46 (60%) were male with a mean age of 7.86±2.30 years. Gartland type I fracture constituted 55.8% (43), type II was 29.9% (23) and type III was 14.3% (11). About 88.3% of the patients were managed non-operatively and 11.7% were managed operatively. The overall satisfactory functional outcome was 46.7%, while 81.8% of the patients had a satisfactory radiological outcome at 6 months after the intervention. Delay in seeking treatment, type 1 fracture, and prolonged duration of immobilization were significantly associated with unsatisfactory functional management outcome. Type II fracture and prolonged duration of immobilization were significantly associated with unsatisfactory radiological management of SCF of the humerus.ConclusionThe short-term functional outcome was unsatisfactory, while a satisfactory radiological outcome was found in most of the patients. Duration of immobilization, type of fracture, and seeking late medical care had a negative impact on the outcome of these fractures.

Analysis of the location and trajectory of the Kirschner wires in the fixation of extension-type supracondylar fracture of the humerus by 3D computational simulation.

Closed reduction and percutaneous pinning is still a preference for the treatment of supracondylar humerus fractures in children. However, no reports have shown the pin trajectory and the characteristics of the entry point so far. So we established a computational simulation model of the elbow to observe the trajectory of pinning for supracondylar humerus fractures. We reconstructed an adult elbow computationally and simulated pin placement through lateral and medial pinning. Pin trajectories were traced after placement and after the addition of the skin profile; the relative entry points of the pins were determined. We used the center of the dorsal olecranon inflection as an anatomic reference for the entry points of lateral pinning. Four quadrants were established based on the center of the dorsal olecranon inflection: upper medial quadrant, upper lateral quadrant, lower medial quadrant, and lower lateral quadrant (LLQ). The maximum angle of pinning through the lateral column was 64°±3°. The minimum angles of pinning through the lateral column and middle column were 37°±3° and 20°±2°, respectively. The range of safe angle pinning through the medial column was between 18°±2° and 57°±3° to avoid penetration of the olecranon fossa and the cortex of the medial column. The entry points of lateral pinning were within the lateral half of the LLQ, and the lateral one-third of the LLQ contained all entry points of the pins through the lateral column and minor points of the pins through the middle column. The exit points of the medial pinning were within the lateral fringe of the metaphyseal-diaphyseal junction region; entering from the inferior two-thirds of the medial epicondyle could lead to the exit points in the proximal half of the metaphyseal-diaphyseal junction region laterally. For lateral pinning, the entry points would be within the lateral half of the LLQ. For the pins through the lateral column, the entry points should be within the lateral one-third of the LLQ. For medial pinning, entering from the inferior two-thirds of the medial epicondyle would lead to a more proximal exit.

The joy stick technique: an easy, reliable, safe and cost effective, technique in closed reduction and percutaneous fixation of supracondylar fracture of the humerus in children

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supra condylar fractures of humerus account for approximately 16% of all pediatric fractures. This produces an extension type fracture in 97–99%. Flexion type accounting for 1-3%. This often causes significant morbidity due to malunion (gun-stock deformity) reported in 12 to 20%, while neurovascular complications and compartment syndrome is documented in worse scenarios.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted with 24 cases of supracondylar humerus fracture between June 2017 to June 2021. Both males and females aged 3 years to 12 years, within 5 days of injury, with modified Gartland’s type III and type IV, without compartment syndrome were included and followed up for 6 months to one year. The fracture was closely reduced using a 2-2.5 mm k-wire (joystick) in proximal fragment placed 5-7 cm proximal to fracture line and fixed with multiple percutaneous pinning under C-arm. All the patients were followed for rate of union and functional outcome using Flynn’s criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the 24 cases were managed by closed maneuver with the help of a joy stick. This reduces the surgical time and stress, preventing opening of fracture. Outcome was assessed in each follow up using Flynn’s criteria. 87.5% of patients had good to excellent outcomes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our results demonstrate that good functional outcomes are expected in supracondylar fracture regardless of age at injury, sex, weight, side of extremity provided satisfactory reduction by closed technique with help of joy stick. This simple technique reduces surgical stress, duration of surgery and also minimizes the C-arm exposure.&lt;/p&gt;

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society.

Purpose:The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society.Methods:The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire.Results:The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of “crucial importance” for expected outcome of supracondylar humerus fractures treatment.Conclusion:Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated.Level of evidence:level II.

Are Children Suffering From Congenital Pseudarthrosis of the Tibia Associated With Decreased Bone Strength?

Background:Congenital pseudarthrosis of the tibia (CPT) is a rare and difficult-to-treat congenital disease in neonates. Our previous study found that exosomes derived from serum of children with CPT inhibit bone formation. In this study, we used ultrasound bone densitometry to detect the bone strength differences between hospitalized children with CPT and with non-metabolic diseases to determine the bone strength of children with CPT.MethodsA total of 37 children with CPT with a mean age of 3.14 ± 1.81 years and 40 hospitalized children with a mean age of 3.32 ± 2.66 years with supracondylar fracture of the humerus and without a bone metabolic disease (control group) were recruited in our hospital. The ultrasonic bone densitometer was used to examine the bilateral calcaneus of the subjects. We collected the broadband ultrasonic attenuation (BUA), speed of sound (SOS), quantitative ultrasound index (QUI), bone strength index (STI) and bone mineral density estimation (BMDe) values. Multivariable regression was used to examine the associations between quantitative ultrasound measurement differences and age, body mass index (BMI), neurofibromatosis type 1 (NF1) and CPT Crawford type. Intra-class correlation coefficient (ICC) was calculated to estimate intra- and inter-rater agreements.Results74 calcaneus scans were taken from CPT patients (23 boys and 14 girls) and 80 calcaneus scans were taken from the control (24 boys and 16 girls). The CPT patients exhibited significantly lower SOS (1,368.75 ± 136.78 m/s), STI (7.2319 ± 38.6525), QUI (8.2532 ± 56.1720), and BMDe (−0.0241 ± 0.3552 g/cm3) than the control (SOS: 1,416.02 ± 66.15 m/s, STI: 7.96 ± 16.884, QUI: 28.8299 ± 25.461, BMDe: 0.0180 ± 0.1610 g/cm3). Multiple regression revealed that SOS, STI and QUI were statistically significant and negatively correlated with CPT Crawford classification.ConclusionsWe found the incidence of decreased bone strength in CPT group was higher than that in the non-bone metabolic disease group. This phenomenon was not related to NF1 but related to CPT Crawford classification, which suggested that the higher the grade of the CPT Crawford classification, the lower the bone strength and the higher the risk of fracture.

A Comparative Study on Outcome of Three Dissimilar Approaches for Supracondylar Humerus Fractures in Children

Aim: To compare the radiological and functional results of lateral, medial and posterior access for K-wire fixation and open reduction among children with type III supracondylar fractures of the humerus. Study Design: A retrospective cohort study. Place and Duration: In the Orthopedic department of PIMS hospital, Islamabad for three-year duration from October 2018 to September 2021. Methods: All children with type-3 supracondylar fractures of the humerus who were operated and followed for at least one year who met the criteria of inclusion were involved in the research. There were 105 total children in this study. Lateral approach, Medial approach and posterior approach was used in 35 children each. Medical records were reviewed for surgical access, and children with lateral (LA), medial (MA), and posterior (PA) access were screened. The radiological result was evaluated by measuring the Baumann angle and Shaft Condylar Angle (SCA). All children were applied with Flynn's criteria for functional results, which were classified as excellent, good, poor (unsatisfactory) and Fair (satisfactory). The results from medial, lateral and posterior approaches were compared and the P value was determined using the Kruskal-Wallis and Chi-square test (significant P value &lt;0.05). Results: There were 105 total children in this study. Lateral approach, Medial approach and posterior approach was used in 35 children each. The mean age of children with Lateral approach was 8.60 ± 4.2 years, Medial approach 7.15 ± 4.1 years and with posterior approach 7.9 ± 5.9 years. The mean angle of the condylar axis was 41.9±7.4°, 42.5 ± 3.2 ° and 42.1±2.1 o in lateral approach, Medial approach and posterior approach respectively (p&gt; 0.05). The mean Bauman angle was 20.1±3.9 o, 21.1±6.1 o and 22.2±3.4 o in lateral approach, Medial approach and posterior approach (P&gt; 0.05). Excellent results were obtained in 25 (71.4%), 19 (54.3%) and 17 (48.6%) patients in lateral approach, Medial approach and posterior approach respectively. (P&gt; 0.05) Good results were obtained in 10 (28.6%) children in LA, 16 (45.7%) children in MA and 18 (51.4%) children in PA (P&gt; 0.05). Conclusions: The lateral approach for the supracondylar fracture gave better functional and radiological results in our patients in comparison to the medial and posterior approach. Though, the difference was not statistically significant. Keywords: Functional outcome, Flynn's criteria, Supracondylar fractures and Open reduction

A prospective study of displaced supracondylar fractures of the humerus in children treated with open reduction and internal fixation with k-wires

Supracondylar fractures of the humerus were the most frequent occurrence, accounting for about 65.4% of all fractures around the elbow in infants. Displaced supracondylar humeral fractures need a high degree of respect and difficulty to be treated, as they require correct anatomical reduction and internal fixation to avoid complications. Thus, in this research, we documented the effects of open reduction and internal fixation with K-wires in the displaced (Gartland type III) supracondylar fracture humerus in infants.The prospective study of 25 cases of displaced (Gartland type III) supracondylar fractures treated with open reduction and internal fixation with K-wires were examined at our institution between September 2019 and July 2020 and followed for an average of 6 months. All Gartland Type III fractures were closed with an average age of 6.3 years in our study of 25 patients, 13 patients had slip fractures while playing, 18 patients had left-hand fractures, and 16 patients had posteromedial displacement. The fracturing of the distal end radius was associated with 2 patients. The majority of patients underwent surgery on the 2nd day and were home on the 3rd postoperative day. 16 had a loss of motion range of 0-5 °; 18 had a loss of motion angle of 0-5 °. 3 patients had inflammation of the superficial pin tract, 2 had traumatic median nerve paralysis, 2 had K-wire migration, 1 had a deformity of the cubitus varus and 1 had &amp;#62;15 loss of motion.This research shows that anatomical reduction, stable fixation with minimal complications has enhanced open reduction and internal fixation with K-wires. Therefore, the present analysis reveals an open reduction, and K-wire internal fixing is most generally known as an option for the reconstruction of infant supracondylar humerus fractures.

Supracondylar fractures of the humerus in children

Supracondylar fractures of the humerus are common fractures in children. Closed reduction and percutaneous pinning is the primary method of management, though 2–12% of these fractures require open reduction. There is no conclusive evidence to dictate the best surgical approach to the fracture. This paper aims to review supracondylar fractures of the humerus and discusses the early and late associated complications. The treatment options are then examined, with a focus on the preferred surgical approach to open reduction. If an Orthopaedic surgeon is going to learn only one approach for reduction of these challenging fractures, then we recommend becoming familiar with the anterior approach. This is the approach one would need to use in most open fractures and in those where exploration of the brachial artery is indicated. It gives access to the neurovascular structures, to the fracture site and also to the soft tissues that are likely to block reduction. The cosmetic and functional outcomes are reported to be good. Upper extremity fractures account for up to 90% of pediatric fractures. Among these fractures Supracondylar Humerus fractures are one of the commonest requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. The epidemiology, classifications, clinical evaluation and complications of this fracture is hereby comprehensively reviewed along with controversies in management and available guidelines.

Epidemiology of Pediatric Musculoskeletal Trauma Patients Admitted to the Trauma Center of King George's Medical University (KGMU) During COVID-19-Induced Lockdown.

Purpose: This retrospective study aims to document the epidemiology of pediatric musculoskeletal trauma patients admitted over a one and half year period to the trauma center of King George's Medical University (KGMU) and the effect of COVID-19-induced lockdown on the timeliness of care.Methods: We analyzed data of 174 patients for demography, types of injuries, mechanism of injuries, the site where the injury was sustained, the severity of injuries, nature of the injury, and the regions involved by the injuries.Results: Mean age was 12.44±4.4. One hundred and twelve (67.46%) were males and 62 were females (32.54%). When compared with the period prior to lockdown, significantly higher times were recorded during the lockdown for time to a reception at the trauma center (p=0.028) and the time spent in receiving area of the trauma center (p<0.001). The most common mode of injury was low energy falls (n=68; 40.96%). The most commonly involved region was the lower limb (n=156; 51.82%). The region involved by the injury and the frequency of fracture types varied with the age of the subjects. The frequency distribution of injuries in males and females was almost similar till the age of nine years. The most common injuries of the lower extremity and upper extremities were fracture shaft of the femur and supracondylar fracture of the humerus, respectively.Conclusion: Our study presents a precise estimate of demography and injury characteristics of pediatric musculoskeletal injuries, which may be helpful in planning and policymaking. The effect of the pandemic on the timeliness of care can be used for improving the infrastructure required to handle future waves of the pandemic.