Supracondylar Humeral Fractures In Children Research Articles

Treatment and Outcome of Supracondylar Humeral Fractures in Children Over 10 Years of Age at the Time of Injury: A Review of 60 Cases.

To assess the treatment and outcomes of supracondylar humeral fractures (SHFs) in children older than 10 years of age at the time of injury. The study analyzed clinical data from 60 patients who sustained SHF, all over the age of 10 years, were analyzed. The patients included 49 males and 11 females with a mean age of 10.9 ± 0.9 years (range, 10 to 14.5). All patients underwent surgical treatment under general anesthesia. Closed reduction (CR) and percutaneous fixation were the primary treatment, with open reduction and internal fixation being employed only in cases CR was unsuccessful. The study assessed the healing of fractures by measuring the radiographic angles, including the carrying angle (RCA), Baumann's angle (BA), and metaphyseal-diaphyseal angle (MDA) on anteroposterior radiographs of the elbow joint. In addition, the study evaluated whether the anterior humeral line (AHL) appropriately passed through the middle third of the capitellum. The final follow-up visit used the Mayo Elbow Performance Index score (MEPI) and Flynn's criteria to analyze the recovery of elbow function. There were 15 (25%) SHF type II, 17 (28.3%) type III and 28 (46.7%) type IV. Of the 60 patients, 56 (93.3%) underwent successful CR, whereas 4 (6.7%) required open reduction and internal fixation because of an unsuccessful CR. The final follow-up showed the average BA as 72° ± 5.3°, the average MDA as 88.3° ± 2.8°, and the average RCA as 9.6° ± 3.9°. The AHL bisected accurately the capitellum in 59 cases (98.3%). The average range of elbow flexion-extension was 146.6° ± 8.6°, whereas the average MEPI score was 99.9 ± 0.6; 98.3% (n=59) were rated as excellent and 1.7% (n=1) were rated as good. According to Flynn's criteria, 86.7% had an excellent outcome (n=52), 10% had a good outcome (n=6), and 3.3% had a poor outcome (n=2). Only 1 patient (1.7%) experienced redisplacement. Eight cases of nerve injury were reported, with 7 involving the radial nerve and 1 involving the ulnar nerve; all resolved spontaneously. CR and percutaneous fixation have been shown to be effective in treating SHF in 93.3% of children aged 10 years old and older at the time of injury, with favorable radiographic and functional outcomes and a low risk of secondary displacement. Open reduction should only be considered when CR is ineffective.

Conservative versus surgical treatment of Gartland type II supracondylar humeral fractures in children.

The purpose of the study was to compare the efficacy of conservative and surgical treatments for Gartland type II supracondylar humerus fractures in children. We assessed 142 patients with type II supracondylar humerus fractures treated in our hospital from February 2018 to February 2019. The patients were divided into two groups: initial conservative treatment (Group A) and initial surgical treatment (Group B). Clinical outcomes were measured by the Flynn scoring system. Variables were analyzed using a statistical approach between those groups. All patients were followed up for 6-12 months. The rate of loss reduction was 19.8% in patients treated conservatively, and the incidence of pin infections was 7.1% in patients treated surgically. Although there were no statistical differences between the three groups in fracture healing time and Flynn score, the conservative treatment was superior to surgical treatment in functional recovery times. At the last follow-up, all fractures had healed without iatrogenic vascular or nerve injury, Volkmann's contracture, or cubit varus deformity. Conservative treatment is safe and effective for the treatment of Gartland type II supracondylar fracture and represents a faster recovery time of elbow range of motion as compared with surgical treatment. Type IIB had a 41.3% risk of secondary displacement versus 5.3% for IIA, but we still prefer closed reduction. However, closed reduction of Garland type II must be followed accurately in the first 2 weeks to identify patients with loss of reduction. The patients who loss reduction can be treated with percutaneous pinning, and the clinical effect was consistent with immediate surgical treatment. Level of evidence: level III.

Early Lateral Closing Wedge Surgical Correction of Cubitus Varus Deformity Complicating Supracondylar Humeral Fracture in Children

Cubitus varus deformity complicating supracondylar fracture of humerus in children usually implies a malunion from inappropriate treatment of the fracture . The resulting deformity can be solved only by osteotomy ,since the deformity once established it will not correct by remodeling . A lot of controversy is still present regarding the best age of the child to perform the corrective osteotomy . Cosmetic appearance is the most common indication for osteotomy

Iatrogenic ulnar nerve palsy associated with supracondylar humeral fracture in children: A systemic review on its management

Background Supracondylar humeral fractures (SCHFs) are among the most common pediatric fractures. Closed reduction and percutaneous pinning are considered the established gold standard. Biomechanically, cross-pinning is resilient for any axial rotation, but the medial pin increases the risk of iatrogenic injury to the ulnar nerve. Objective A systematic review was conducted to provide an evidence-based analysis of the literature on the management of iatrogenic ulnar nerve injury caused by the medial pin during closed reduction and percutaneous fixation of displaced SCHF in children. Methods MEDLINE, SCOPUS, and ScienceDirect databases were searched to identify all articles that reported ulnar nerve injury caused by the medial pin during closed reduction and percutaneous fixation of displaced SCHF in children and suggested the management. Reference lists from the articles retrieved were further scrutinized to identify any additional studies of interest. Results One thousand six hundred and six articles on SCHF treated by closed reduction and cross-pinning were identified initially with 25 studies included in the analysis after screening. Four thousand six hundred and seventy-five children sustained SCHF with a median age of 7 years. Of 3036 children treated by closed reduction and cross pinning, 205 (6.75%) were diagnosed with iatrogenic ulnar nerve injury. The management involves observation only, removal of the medial pin, or exploration. The average recovery time in the group treated by removal of wire was statistically shorter than the other two groups. Conclusion The evidence suggests surgical exploration of the ulnar nerve can be delayed for up to 7 months, with most studies favouring observation only. In selected cases, immediate removal of the medial pin should be considered.

Outcomes of Open Reduction and Internal Fixation for Supracondylar Humeral Fractures in Children

Objectives: The aim of this study was to evaluate the results of open reduction and internal fixation of humeral supracondylar fractures in pediatric patients. Patients and methods: A retrospective descriptive study conducted from 2006 to 2016, including 24 patients who underwent open reduction and internal fixation for the treatment of condylar fractures, adjusted by the closed method. The patients were clinically and radiographically evaluated according to the Gartland’s classification. Data collection also included postoperative radiological assessment, range of motion, presence of postoperative complications, and satisfaction questionnaire with treatment received. Results: Patient’s age: Mean 9.46 ± 2.07; Males : 15 (62.5%), Femeals: 9 (37.5%); Injured elbow: Left 17 (70.8%), Right 07 (29,2%); Injury/Sugery Interval (days): 2.2 ± 0.78; Gartland’s classification: Type II: 6 (25%), Type III: 17 (70.8%), Type IV: 1 (4.2%); Foll-up Period (months): 44. 08 ± 5.78; Baumann angle: 16.12° ± 2.23°; Final loss of flexion: averaged 5.9°; loss of extension: 0.73°. The KW was removed was 4.2 months (range: 3 - months). Complications: KW Pierce through brachial artery (intra - Operatively) 1 (4.2%), Iatrogemic ulnar injury 1 (4.2%), Cubitus varus 1 (4.2%). Evaluation: Satisfactory 22 (91.7%), Unsatisfactory 02 (8.3%). Conclusions: Conservative treatment is recommended for Gartland type I and nondisplaced type II fractures. Open reduction with two or three pins is the preferred treatment option for most supracondylar fractures. The use of appropriate criteria is wise in managing these cracks; Prognosis in the event of complications or possible complications should be explained.

Functional outcome of carrying angle changes following supracondylar humeral fractures in children

Functional outcome of carrying angle changes following supracondylar humeral fractures in children

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children

To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

THE OUTCOME OF THREE LATERAL DIVERGENT PINNING VS PARALLEL PIN FIXATIONS FOR THE TREATMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN.

Supracondylar humerus fracture is the most common type of elbow fracture in children younger than 15 years. This hospital based prospective study evaluated different pinning xations which is used in the treatment of Gartland Type II and Gartland Type III supracondylar humeral fractures in children with closed fractures ≤7 days old, extension type, for comparing clinical, radiological and functional outcome of lateral parallel and divergent pinning for displaced supracondylar fractures in children.The study was conducted from May 2021 to May 2022. The mean age was 8.2 years for Divergent pinning group and for Parallel pinning group, the mean age was 9.2 years. Functional outcome were measured using Flynn's criteria &amp; radiological outcome measured using Baumanns angle &amp; carrying angle. Divergent pinning group had 12 males and 7 females while Parallel pinning group had 15 males and 5 females. The time interval between injury and surgery was less than 12 hours in 84.21% of Divergent pinning group &amp; 95% in Parallel pinning group. In our study the duration of surgery was less than 35 minutes in 68.5% in Divergent pinning group and 85% in Parallel pinning group. Patients were followed up clinicoradiologically at 3 weeks, 6 weeks, 3 months &amp; 6 months post operatively &amp; assessed for elbow function, carrying angle, rate of union etc., during each follow up. In our study divergent pinning gave better results than parallel pinning as the latter encountered slower rate of union and varus deformities (loss of carrying angle and baumanns angle).

Closed Reduction Percutaneous Pinning Compared With Open Reduction Internal Fixation In Treating Supracondylar Fractures: A Systematic Review

Background: Supracondylar fractures are one of the most frequent pediatric bone fractures. There are well-known treatments for this fracture. The most commonly used procedure is closed percutaneous reduction pinning, and open reduction internal fixation is for irreducible fractures. This study aims to evaluate and review those two procedures in treating a supracondylar humeral fracture in children by evaluating the clinical and functional outcomes.Methods: Systematic review and meta-analysis (PRISMA) were conducted. Using Boolean operators, literature was searched through PubMed, Google Scholar, Science Direct, and Cochrane Library. The outcomes assessed by Flynn's criteria include functional aspects, cosmetic factors, and other outcomes.Results: From 130 studies obtained, after a full-text review, four studies were included in the systematic review. The total sample size was around 268 patients with a mean age of 4-14. Male patients were higher than females. There is no significant difference in satisfactory outcomes measured by Flynn’s Criteria.Discussion: Flynn's criteria was found to be different in the result of the studies. Insignificant loss of carrying degree and Baumann's angle between two procedures. Some complications, like nerve injury, infection, and scar, were also seen after surgery.Conclusion: The two approaches have an insignificant difference in their functional outcome. The choice of which procedure to perform relies on the surgeon’s preference and the situation of the fractures.

Double joystick technique - a modified method facilitates operation of Gartlend type-Ⅲ supracondylar humeral fractures in children.

Gartland type-Ⅲ supracondylar humerus fracture (SCHF) is a severe lesion with the feature of difficult reduction. Due to the high failure rate of traditional reduction, a more practical and safer method is needed. This retrospective study aimed to explore the effectiveness of the double joystick technique during the closed reduction of children with type-III fractures. Forty-one children with Gartland type-Ⅲ SCHF underwent closed reduction and percutaneous fixation using the double joystick technique at our hospital between June 2020 and June 2022, and 36 (87.80%) patients were successfully followed up. The affected elbow was evaluated by the joint motion, radiographs, and Flynn's criteria then contrasted with the contralateral elbow at the last follow-up. A group of 29 boys and seven girls with an average age of 6.33 ± 2.68 years. The mean time of surgery and hospital stay was 26.61 ± 7.51 min and 4.64 ± 1.23 days, respectively. After a mean follow-up of 12.85 months, the average Baumann angle was 73.43 ± 3.78°, although the average carrying angle (11.33 ± 2.17°), flexion angle (143.03 ± 5.15°), and extension angle (0.89 ± 3.23°) of the affected elbow were less than those of the contralateral elbow ( P < 0.05), the mean range of motion difference between two sides is only 3.39 ± 1.59°, with no complications. Furthermore, 100% of patients recovered satisfactorily, with excellent outcomes (91.67%) and good outcomes (8.33%). The double joystick technique is a safe and effective method that facilitates the closed reduction of Gartland type-Ⅲ SCHF in children without raising the risk of complications.

Management of Supracondylar Fractures of the Humerous in Children

Background: Supracondylar humeral fractures (SFH) are the most common fractures of the pediatric elbow, having a peak frequency between the ages of four and nine years. The majority of surgical therapy is percutaneous pinning and closed reduction. The present study aimed to determine the outcome of close reduction and percutaneous pinning in managing the supracondylar humeral fractures in children. Patients and Methods: A total of 64 children presented with supracondylar humeral fractures to the Orthopaedics Unit of Bacha Khan Medical Complex, Swabi during the period from 16th February 2022 to 15th November 2022. Children with supracondylar humerus fractures of completely displaced (Gartland Type III) were enrolled whereas neurovascular injury related to open or closed Gartland type-III fracture were excluded. Under general anesthesia, close reduction was accomplished, and the elbow was immobilized in extension by the implantation of two plaster slabs. The type of fracture, injury pattern, time from injury to final therapy, surgical treatment, and consequences were all recorded. Results: The overall mean age was 4.89±3.2 years. Of the total 64 SFH cases, there were 52 (81.3%) male and 12 (18.7%) females. Out of 52 (81.3%) children with pulseless hands, the incidence of Gartland type III and IV was 15.4% (N=8) and 84.6% (N=44) respectively. Out of 52 cases, there were 19 (36.5%) cold hands and 33 (53.5%) warm hands. The overall mean time between injury and presentation was 3.8±2.4 hours. The incidence of patients undergoing autologous interposition venous grafting, vascular reconstruction, and segmental resection and primary anastomosis was 25% (N=16), 59.4% (N=38), and 15.6% (N=10) respectively. There were no amputations, fasciotomies, re-explorations, or long-term ischemic sequelae. Conclusion: The present study found that close reduction and immobilization with two slabs is a safer and effective method for superior outcome of managing supracondylar humeral fractures in uncomplicated type III injuries as compared to flexion approach. Additionally, Rapid vascular exploration might effectively treat both cold and warm pulseless hands. Keywords: Supracondylar humeral fractures, Management, Children, Close reduction approach

Technique for facilitating closed reduction of difficult flexion type supracondylar humeral fracture in children.

The displaced flexion type supracondylar humeral fractures (SCHF) are inherently unstable and there is great intraoperative difficulty in obtaining and maintaining the fracture reduction by closed means. We introduced a technique for closed reduction and K-wires pinning of displaced flexion type SCHF. Fourteen patients with flexion-type SCHF (9 boys and 5 girls) underwent a reduction technique using a construct of three K-wires. The proximal wire was used for rotational control of the proximal fragment and the two distal wires were used for correction of the flexion and rotational deformity of the distal fragment. The patient's mean age was 7 (6-11) years. Results were evaluated by the anterior humeral line, Baumann's angle, carrying angle radiographically and Flynn's criteria clinically. The mean time for the union was 4.8 (4-6) weeks. The anterior humeral line passed through the middle one-third of the capitulum in 12 patients and the anterior third in two patients. The mean Baumann's angle was 19.60 ± 3.8 and the mean carrying angle was 14.21 ± 3.04. We reported no cases of failed closed reduction. The median operation time in this study was 30 (25-40) min. The mean number of C-arm images was 33.5 ± 5.23. According to Flynn's criteria; 10 cases (71.4%) were excellent and 4 (28.6%) were good. This technique can achieve the accurate reduction of flexion type SCHF and avoid the complications of both repeated closed reduction trials and open reduction. Level of Evidence: Level IV, case series.

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.

Comparative Outcome of Three Different Approaches for Supracondylar Humeral Fractures in Children in Khyber Pakhtunkhwa, Pakistan

Background: The closed reduction and percutaneous pinning are the min treatment approaches tested in pediatric humerus supracondylar fractures but the treatment approach preferred in fractures without closed reduction is remains unclear. Objectives: The purpose of this study was to compare three common orthopaedic procedures for treating children with supracondylar humerus fractures of the displaced extension type. Methods: The current retrospective analytical study was started in the Department of Orthopedic at Khyber Teaching Medical College from 2015 to 2020, with the approval of the clinical research ethics committee. This analysis was conducted on 64 patients between the ages of 1 and 12 years who underwent hospital surgery for Gartland IIb, Gartland IIb, and Gartland III supracondylar humerus fracture. Results: A total of 64, 22 patients were from group A, in which 18 (81.81%) were male and only 4 (18.18%) were female, while in group B and C were 21 (80.76%), 5 (19.23%) and 14 (87.5%), 2 (12.50%) male and female, respectively. The injury on left elbow and right elbow in group A was recorded 68.18 and 31.81%, respectively. Among the total injured children, the left elbow was fractured in 47 (73.43%) case and the right one in 7 (10.93%). Approximately the duration of injury to therapeutic procedure was recorded 7.53±3.03 hours in the study. When compared to the group of displaced supracondylar humeral fractures that were conservatively handled, the functional and aesthetic treatment outcomes between the closed and open reduction with K-wire fixation groups were significantly different. According to this system, excellent, fair, good and poor functional outcomes were recorded in 10 (45.45%), 6 (27.27%), 4 (18.18%) and 2 (9.09%) patients of A group, respectively, while 13 (50%), 5 (19.23%), 5 (19.235), and 3 (11.50%) patients in group B, respectively. The poor and fair functional outcome was noted in 1 (6.25%) and 3 (18.75%) patients, respectively in group C. Practical implication: This is a critical surgical condition in children and they should be provided with the appropriate treatment to acquire the child's ability of movement. According to our findings among three management techniques, the most favorable was open reduction with K-wire fixation, and therefore was recommended with good success rate. Conclusion: It was thus concluded that open reduction with K-wire fixation is a good alternative to closed reduction with percutaneous pinning for treating displaced pediatric supracondylar humeral fracture. Keywords: Children; Supracondylar humerus fracture; Surgical treatment; Pediatric fractures; Pakistan

Small incision reduction and external fixation for the treatment of delayed over fourteen days supracondylar humeral fractures in children.

Supracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique. Between October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments. A total of 11 children (aged 4-13 years) with delayed presentation (range, 14-22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria. The results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.

Early Versus Delayed Treatment for Gartland Type III Supracondylar Humeral Fractures in Children: A Systematic Review and Meta-analysis

PurposeThe timing of treatment for Gartland type III supracondylar fractures has been an area of contention as it was previously thought to be a surgical emergency. The aim of this systematic review and meta-analysis is to clarify whether there is a difference in perioperative outcomes between early and delayed treatment for Gartland type III supracondylar humeral fractures in children.MethodsLiterature search and study selection were performed according to the PRISMA process. The early surgery (ES) and delayed surgery (DS) groups were defined by the authors of each study included, based on the time to surgery. The primary outcome was the risk of conversion to open reduction. The secondary outcome was perioperative complication risks.ResultsA total of 14 studies met the eligibility criteria (n = 1263 patients), of which 665 (52.7%) patients had undergone early surgery, while 598 (47.3%) had delayed surgery. On meta-analysis, there was no significant difference between ES and DS for the outcome of open reduction conversion risk. There was also no significant difference for the secondary outcomes of post-operative compartment syndrome, iatrogenic nerve injury, vascular injury, and surgical site infection.ConclusionDespite the limitations in the literature, evidence exists to support the notion that a delayed approach to the surgical treatment of Gartland type III supracondylar humeral fractures in children does not result in an increased risk of converting to open reduction and perioperative complications.

Comparison of Open reduction and internal fixation by Stabilization with cross K-wires in early versus late presentation of Supracondylar Humeral Fractures in Children

Objective: To compare open reduction and internal fixation by stabilization with cross k-wires in early (within 6 days of injury) versus late (2 to 4 weeks) presentation of supracondylar humeral fractures in children. Study Design: A quasi experimental study Place and Duration: Department of Orthopedic, Lahore General Hospital, Lahore from 1st January 2021 to 30th June 2021. Methodology: A total of 42 cases (21 children in Group-A with early presentation and 21 in Group-B with late presentation) of Gartland’s type II and III humeral supracondylar fracture were included. All open reduction and internal fixation procedures were done by a single surgical team while post-surgical follow up consisted of 3-months. Functional and cosmetic outcome of surgery were observed in terms of decrease in carrying angle and elbow movements as per Flynn’s criteria. Results: Out of a total of 42 cases, there were 71.4% male and 28.6% female. The mean age of children in Group-A was 8.29±1.85 years while it was 7.43±2.06 years in Group-B. Mean procedure time was noted to be 0.91±0.35 hours in Group-A and 1.38±0.25 hours in Group-B (p&lt;0.001). All cases were found to have satisfactory wound condition and bony union. Decrease in range of motion of elbow as 0-50, 6-100,and 11-150 in 10, 9 and 2 cases in Group-A respectively in comparison to 4, 14 and 3 cases in Group-B respectively (p=0.145). Functional outcome in 33.3% cases was excellent, good in 54.8% and fair in 11.9% cases while there was no difference in between both study groups (p=0.145). Conclusion: There is no significant difference in functional outcomes of early or late presentation in children undergoing open reduction and internal fixation for supracondylar fractures. Keywords: Supracondylar fracture, Humerus, Children, Early presentation, Late presentation, Open reduction, Internal fixation, K-wire stablization, Functional outcome.

Clinical study of outcomes of supracondylar osteotomy in correcting cubitus varus deformities

Background: It is the most frequent complication of treatment for supracondylar humeral fractures in children. Although cubitus varus has been conventionally described as a cosmetic deformity with little functional significance, Supracondylar fracture of humerus is one of the commonest fractures sustained by children. It is one of the difficult fractures to treat due complications like malunion, neurovascular injury, ischemic contracture. Much attention paid to prevention of malunion by anatomical reduction either by closed or open method. The present study evaluates a technique of correction of post-traumatic cubitus varus in children with a laterally based closing-wedge osteotomy of the distal humerus with medial displacement of distal fragment, through a lateral approach and fixation with percutaneous Kirschner wires. Material and Methods: A Retrospective study, which was conducted in department of Orthopaedics of Maharaja Agrasen Medical College, Agroha, Haryana, India, in 42 children with cubitus varus deformity following supracondylar fracture of humerus, were treated by lateral closing wedge osteotomy with medial displacement of distal fragment and fixation with percutaneous K-wires. Out of these, 36 children who satisfied the inclusion and exclusion criteria, and were available for assessment of final outcome were included in this study.

Transphyseal Distal Humeral Fractures: A 13-Times-Greater Risk of Non-Accidental Trauma Compared with Supracondylar Humeral Fractures in Children Less Than 3 Years of Age.

The transphyseal distal humeral fracture has been well described as a concerning fracture pattern for non-accidental trauma (NAT) in young pediatric patients. Because of the infrequent presentation of this fracture, the association historically has been anecdotal. The purpose of this study was to determine and compare the incidence of NAT among displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in children <3 years of age. All displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in patients <3 years of age admitted because of injury during an 18-year period were reviewed retrospectively for inclusion. Patient demographics, mechanisms of injury, results of child protective services investigations, and medical records were reviewed. A chi-square test was utilized to analyze significance for categorical data; p values of <0.05 were defined as significant. The charts of 23 transphyseal distal humeral and 205 supracondylar humeral fracture cases were reviewed. NAT was the cause for 6 (26%) of the displaced transphyseal distal humeral fractures and 4 (2%) of the displaced supracondylar fractures. The associated risk of NAT was 13 times greater (95% confidence interval [CI], 4.05 to 43.7; p < 0.001) for children admitted for operative management of displaced transphyseal distal humeral fractures compared with those admitted for operative management of displaced supracondylar humeral fractures. The classic 1980 paper by DeLee et al. sensitized the orthopaedic community to the relationship between transphyseal distal humeral fractures and child abuse. Our study is the first, to our knowledge, to bring statistical weight to this association. We found a 13-times-greater risk of NAT for children <3 years of age who sustain a displaced transphyseal distal humeral fracture compared with a displaced supracondylar fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Functional and radiological outcome of gartland type 2 and 3 supracondylar fracture humerus in children treated by percutaneous pinning

Supracondylar fracture of Humerus is the commonest injury around the Elbow in children. It constitutes about 60% of all the fractures about the Elbow in children. The aim of the present study is to evaluate the results of percutaneous pinning of unstable or irreducible Type II and III Supracondylar Humeral fractures in children. A prospective study was conducted on 30 children, taking into consideration age, gender, affected side, mode of injury, type of fracture, Gartland classification of fractures, time duration between injury and surgery, postoperative complications and radiographic and clinic variables.: The median loss of motion was 5 degrees and the median change in carrying angle was 4 degrees. All patients had satisfactory results in terms of Loss of Carrying angle, Limitation of Elbow flexion and Flynn’s grading. There were 19 patients that had excellent ratings, 9 patients had good ratings and lastly only 2 patients had fair Flynn’s ratings. There was only 01 patient suffering from neurological deficit and only 01 patient from pin track infection. Percutaneous fixation with two crossed Kirschner wires leads to good functional and radiological outcome of Gartland type 2 and 3 supracondylar fracture humerus in children.