Treatment Of Supracondylar Humeral Fractures Research Articles

Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures.

Background and Objectives: Long-term outcomes of immediately postoperative rotational malreduction in the axial plane after operative treatment of supracondylar humeral fractures (SCHF) are unknown. This study aimed to investigate the long-term clinical outcomes and associated factors for immediately postoperative rotational malreduction of SCHF. Materials and methods: In this retrospective case-control study, 88 patients who underwent surgery for Gratland type III SCHF were enrolled between January 2012 and January 2020. Among them, 49 patients had immediately postoperative malrotational reduction (rotational malreduction group) and 39 patients had no rotational deformity (control group). To evaluate the associated factors for immediately postoperative rotational malreduction, demographic data, fracture patterns, physical examination signs, and preoperative radiological parameters were analyzed. To compare the clinical outcomes, operation time, range of motion of the elbow, time from operation to full range of motion, and Flynn criteria were evaluated. The Oxford elbow score was used to investigate long-term clinical outcomes for patients five years after operation. Results: The mean age was 5.7 ± 2.3 years and mean follow-up period was 15.7 ± 4.0 months. The rotational malreduction group had significantly more patients with oblique fracture pattern (p = 0.031) and Pucker sign (p = 0.016) and showed a significantly longer operative time (p = 0.029) than the control group. Although there was no significant difference in the range of elbow motion and the Flynn criteria, the Kaplan-Meier survival curve showed a longer time to recover the full range of elbow motion in the rotational malreduction group (p = 0.040). There were no significant differences in the long-term clinical outcomes assessed using the Oxford elbow score (p = 0.684). Conclusions: Oblique fracture pattern and Pucker sign may be associated with immediately postoperative rotational malreduction in the axial plane. Although patients with immediately postoperative rotational malreduction showed favorable results of long-term clinical outcomes, they required more weeks to recover the full range of elbow motion.

Finite element analysis of modified Slongo's external fixation in the treatment of supracondylar humeral fractures in older children.

Older children over 8 years old are at higher risk of elbow joint stiffness after treatment of supracondylar humeral fractures. The objective of this study was to improve the Slongo's external fixation system for treating supracondylar humeral fractures in older children. This would be achieved by increasing fixation strength and providing a theoretical basis through finite element analysis and mechanical testing. A 13-year-old female patient with a history of previous fracture was selected for CT data processing to create a three-dimensional model of the distal humerus fracture. Two internal fixation models were established, using the Slongo's external fixation method with Kirschner wire (Group A) and modifying the Slongo's external fixation (Kirschner wire tail fixation) (Group B). The fracture models were then subjected to mechanical loading analysis using Finite Element Analysis Abaqus 6.14 software to simulate separation, internal rotation, and torsion loads. A PVC humeral bone model was used to create a supracondylar fracture model, and the A and B internal fixation methods were applied separately. The anterior-posterior and torsional stresses were measured using the Bose Electroforce3510 testing system, followed by a comparative analysis. The finite element simulation results showed that under the same tensile, torsion, and inversion forces, the osteotomy model fixed with Kirschner wire at the distal end in Group B exhibited smaller tensile stress and deformation compared to the unfixed osteotomy model in Group A. This indicated that the fixation strength of Group B was superior to that of Group A. According to the test results of the Bose Electroforce3510 testing system, a simple linear regression analysis was conducted using SPSS software. The K values of rotation angle-torque tests and front and rear displacement-stress tests were calculated for Groups A and B, with Group B showing higher values than Group A. The results of this study supported the significantly enhanced biomechanical reliability and stability of fracture fixation in Group B, which utilized the modified Slongo's external fixation (Kirschner wire tail fixation). This optimized method provides a new choice for the clinical treatment of supracondylar humeral fractures in older children, backed by both clinical evidence and theoretical basis.

Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques

IntroductionIn the surgical treatment of supracondylar humeral fractures (SHF), the surgeon has to stand right next to the fluoroscopy device, so it is very important to know how to use it in the most appropriate way to reduce radiation exposure. The aim of this study was to investigate the effect of using C-arm in uniplanar (inverted) and biplanar (standard-horizontal) configurations on (1) the radiation exposure to the surgeon, and (2) surgical time and fluoroscopy exposure time. Material and methodsThis prospective randomised study was conducted on 20 patients who underwent fluoroscopy during closed reduction and percutaneous pinning for a SHF. In the first configuration, the C-arm was inverted and the image intensifier was used as a surgical table. In the second configuration, the C-arm was used biplanar. The operations were performed by 5 surgeons, with each surgeon using each method only twice. During the operation, to find a value closed to direct radiation exposure measurement was made by attaching a dosimeter to the wrist and scatter radiation exposure was measured by attaching a dosimeter to the neck and waist of the surgeons. The operation time and fluoroscopy exposure time were determined. ResultsThe duration of operations performed with the biplanar C-arm position and the fluoroscopy exposure time in operations performed with the uniplanar method were found to be statistically significantly longer (p = 0.001). The measurements on the dosimeter worn on the neck of surgeons were found to be statistically significantly higher while using the uniplanar C-arm configuration (p = 0.001). There was no statistically significant difference between the dosimeter measurements on the wrists and waists of the surgeons and the C-arm configurations (p = 0.820; p = 0.185). ConclusionsAlthough the use of biplanar C-arm has no effect on radiation exposure to the surgeon's wrist, the most important advantages are that the neck area is exposed to less radiation and it shortens the fluoroscopy time so the use of a biplanar C-arm can be recommended. Level of evidenceLevel II

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

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

Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation

BackgroundSupracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation. MethodsWe retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations. ResultsAll patients were followed up for 8–28 months (average, 16.63 months). The fractures healed in 4–6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome. ConclusionClosed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.

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.

Efficacy of ultra-early rehabilitation on elbow function after Slongo\u2019s external fixation for supracondylar humeral fractures in older children and adolescents

ObjectiveTo evaluate the efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents.MethodsWe retrospectively analyzed clinical data from 49 older children (> 8 years) and adolescents with supracondylar humerus fracture who were treated with Slongo’s external fixation in our hospital from January 2016 to August 2020. Twenty-three patients received ultra-early postoperative rehabilitation (rehabilitation group) and 26 patients were not subjected to postoperative rehabilitation (control group). Time to ROM required for functional activity of daily living(ROM-ADL) in both groups was recorded postoperatively. Patients were followed up at 3 and 6 months after surgery to compare the elbow range of motion (ROM) and carrying angle (CA). Postoperative complications were assessed in both groups. Flynn scores and modified Mayo Elbow Performance Scores were also performed.ResultsThe elbow function at 6 months after surgery was significantly better than that at 3 months in the control group (P = 0.32). Time to ROM-ADL in the rehabilitation group was significantly shorter than that of the control group (P = 0.028). The elbow function, Flynn scores, and modified Mayo scores in the rehabilitation group at 3 and 6 months after surgery were significantly better than that of the control group (P(ROM, 3 months and 6 months) = 0.012 vs 0.039; P(Flynn scores, ROM, 3 months and 6 months) = 0.028 vs 0.005; P(Flynn scores, CA, 3 months and 6 months) = 0.032 vs 0.026; P(Modified Mayo scores, 3 months and 6 months) = 0.039 vs 0.024; respectively). There were no iatrogenic injuries, secondary fracture displacements, myositis ossificans, elbow deformities, or other complications in either group. One case of nail tract infection occurred in the rehabilitation group and was cured.ConclusionSlongo’s external fixation is a safe and effective surgical treatment for supracondylar humeral fractures in children over 8 years old and adolescents. Ultra-early rehabilitation treatment for postoperative children can significantly speed up the recovery after surgery.

Lateral entry pins and Slongo\u2019s external fixation: which method is more ideal for older children with supracondylar humeral fractures?

ObjectiveThe standard surgical treatment for supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Given the need for greater fixation strength and higher risk of joint stiffness for children older than 8 years, external fixation is often performed for treating supracondylar humeral fractures in older children. The aim of this study was to compare the efficacy of lateral entry pins and Slongo’s external fixation for treating supracondylar humeral fractures in older children.MethodsChildren older than 8 years who underwent surgery for supracondylar humeral fractures at our hospital for surgery from January 2016 to December 2020 are to be retrospectively assessed. One group (n = 36) underwent internal fixation and percutaneous pinning with three lateral Kirschner wires, and the other group (n = 32) underwent Slongo’s external fixator surgery. The demographic data, operation duration, number of fluoroscopies, and fracture healing time were compared between both groups. The elbow joint function was evaluated 6 months after the surgery on the basis of fracture healing time, lifting angle, elbow joint range of motion (ROM), and Flynn score. The incidence of postoperative complications was also recorded.ResultsThere was no significant difference between the two patient groups in terms of the demographic parameters. Compared to external fixation surgery, Kirschner wire surgery required shorter duration and fewer fluoroscopies (P < 0.05). Nevertheless, the fracture healing time was significantly less (P < 0.05), and the elbow ROM and Flynn scores were higher in the external fixator group compared to the Kirschner wire fixation group (P < 0.05). There was one case of secondary fracture displacement in the Kirschner wire group and one of pin tract infection in the external fixator group. No other iatrogenic injuries or complications were observed.ConclusionMaybe Slongo’s external fixator is a suitable alternative treatment option for supracondylar humeral fractures in children older than 8 years since it can achieve better fixation strength and early restoration of elbow joint movement with a lower risk of joint stiffness.

Open Reduction of Neglected Supracondylar Humeral Fractures With Callus Formation in Children.

The standard treatment for supracondylar humeral fractures (SHFs) in children is closed reduction and percutaneous Kirschner (K)-wire fixation. In patients who present >14 days after injury and show callus formation, this procedure cannot be performed. There are 2 options in these cases: functional exercises with osteotomy performed at a later stage if cubitus varus is present, or immediate open reduction and percutaneous K-wire fixation. This study aimed to evaluate the outcomes of K-wire fixation through an anterior approach in children with neglected SHF and identify factors predicting the outcomes. This retrospective study assessed the files of 32 children treated for neglected SHF at our hospital between June 2015 and May 2018. An incision was made along the anterior transverse groove of the elbow. The callus was removed, the fracture was reduced, and K-wire fixation was performed. The outcome evaluation included the radiological Baumann angle, pin fixation construct, carrying angles, and the functional outcome was Mayo Elbow Performance Score and Flynn criteria. Binary regression analysis compared the functional outcome as the dependent variable with age, time from injury to operation, operation time, and the amount of callus. The interval between injury and operation was 14 to 40 days (average, 22.4 d). Patients were followed for 12 to 36 months (average, 21.5 mo). Fracture healing took 5 to 8 weeks (average, 6.6 wk). No patient had a vascular injury or compartment syndrome. Twelve patients were intraoperatively assessed for radial and median nerve injury. No nerve repair was required. All nerve injuries recovered within 3 months. No iatrogenic ulnar nerve injury occurred. One patient had an infected incision. Binary regression analysis showed that the time elapsed between injury and operation (P=0.033) and Gartland type (P=0.008) were inversely correlated with outcomes; the longer the duration, the poorer the outcomes. The functional outcomes after open reduction and K-wire fixation through an anterior approach were poorer with longer time to surgery and Gartland type. Level III.

Efficacy of Physiotherapy in Improving the Range of Motion of Elbow after the Treatment of Pediatric Supracondylar Humeral Fracture

Introduction: Temporary stiffness of elbow range of motion (ROM) after treatment of supracondylar humeral fracture in children is often a parental concern.Objectives: We examined the role of physiotherapy in improving the elbow ROM in management of supracondylar humeral fracture in children.Methodology: Sixty-four patients were randomly divided into intervention and control groups. Then intervention group patients received regular physiotherapy sessions while control group patients were not sent for physiotherapy. We assessed the outcome according to Flynn criteria during their follow-ups at two, six and 12 weeks, after removal of cast/k-wires.Results: In intervention group, 77.4% children had excellent outcome, and in control group, 80.6% children had excellent outcome. However, we did not find any statistically significant association between physiotherapy and outcome at 12 weeks, after controlling for baseline characteristics in multivariable regression model.Conclusion: Children managed by close reduction for uncomplicated supracondylar humeral fracture with immobilization for three weeks regain their functional ROM within 12 weeks of mobilization by themselves, with no added benefit from physiotherapy.BJHS 2018;3(2)6: 432-436.

K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures

Objective To evaluate K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures of Gartland types Ⅱ&Ⅲ. Methods From June 2014 to March 2016, 31 children with irreducible supracondylar humeral fracture were treated operatively in our hospital. They were 23 boys and 8 girls, aged from 4 to 11 years (average, 6.3 years), involving 19 left and 12 right arms. Their clinical manifestations included elbow swelling at the affected arm, obvious tenderness, and limited movement of the elbow. The reduction was conducted under the guidance of C-arm roentgenography by inserting a piece of 3.0 mm K-wire into the fracture ends via the posterior triceps tendon, inserting 2 pieces of 1.5 or 2.0 mm K-wire from the distal lateral humerus to the proximal through the opposite cortical bone, and inserting a piece of 1.5 or 2.0 mm K-wire into the opposite cortical bone through the ulnar aspect of the distal humerus. Results The operation time for the 31 patients ranged from 28 to 42 minutes (33 minutes on average). They were followed up for 6 to 18 months (12.3 months on average). All fractures united after 4 to 6 weeks (4.6 weeks on average). At the final follow-ups, the lengths of the affected and healthy arms were respectively 66.4±2.7 cm and 66.4±2.9 cm, showing no significant difference (P>0.05). The therapeutic outcomes by the Flynn criteria for the elbow function were rated at the final follow-up as excellent in 26 cases, as good in 4 and as fair in one, yielding an excellent to good rate of 96.8%. Pin tract infection occurred in 2 patients, but no deep infection or osteomyelitis was observed during follow-ups. Conclusion K-wire leverage reduction and fixation via the triceps is an effective and simple treatment for irreducible supracondylar humeral fractures of Gartland types Ⅱ&Ⅲ. Key words: Humeral fractures; Fracture fixation, internal; Kirschner wire; Children

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures.

Background:Optimization of the electronic medical record (EMR) is essential to support the clinician and to improve the quality and efficiency of patient care. The present report describes the development and implementation of a standardized template that is embedded in the EMR and is focused on a comprehensive physical examination during the evaluation of pediatric supracondylar humeral fractures. We compared the completeness of physical examinations as well as the timing of detection and documentation of neurovascular injuries before and after implementation of the template. We hypothesized that the use of a template would increase the completeness of examinations and would lead to earlier documentation of neurovascular injuries.Methods:A multidisciplinary quality-improvement task force was created to address neurovascular documentation practices for patients who underwent operative treatment of supracondylar humeral fractures. Following a series of formative and process evaluations, a standardized EMR template was implemented. Neurovascular examination documentation practices that were in use before (pre-template group, n = 224) and after (template group, n = 300) the implementation of the template were compared. Logistic regression analyses of the 2 groups were used to compare the likelihood of a complete neurovascular examination and the timing of neurovascular injury identification.Results:There was significant improvement in the documentation of the vascular (odds ratio [OR], 70.7; 95% confidence interval [CI], 39.5 to 126.6; p < 0.0001), motor (OR, 17.6; 95% CI, 9.5 to 32.7; p < 0.0001), and sensory (OR, 23.9; 95% CI, 12.9 to 44.4; p < 0.0001) examinations in the template group. Neurological injuries were more likely to be identified preoperatively in the template group compared with the pre-template group (OR, 6.8; 95% CI, 1.7 to 27.1; p = 0.0067).Conclusions:The incorporation of a standardized template in the EMR improved the completeness and timing of documentation of neurological injury. Standardized EMR templates developed by a clinically driven multidisciplinary task force have the potential to improve the quality of clinical documentation and to ease communication among providers.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence.

Double plating as treatment for supracondylar humeral fractures

Introduction and objectivesSupracondylar humeral fractures represent only about 0.5–1% of all fractures in adults. The objective of this study is to evaluate functional outcome and quality of life in patients treated with open reduction and internal fixation using double plates. Material and methodsWe designed a retrospective descriptive study including 27 supracondylar humeral fractures treated with open reduction and internal fixation using two anatomic plates from January 2005 to September 2012. Mean age was 56±22.9 years including 14 female and 13 male. All fractures were classified using the AO classification. Average follow-up was of 41±23.9 months. Fracture union was evaluated with X-ray exams and functional outcome using the Mayo Elbow Performance Score (MEPS). Quality of life was evaluated using the Short Form-36 survey. ResultsUnion at 6 months was achieved in 96% of all fractures. Average range of motion was 102° (70–140°) and average MEPS 86 points (60–100). Mean score on SF-36 was 54.87 (8.66–89.22) the older patients had lower scores. Sixty percent of patients (15 of 25) were able to return to previous activity. No infection was reported. Two patients required surgical treatment due to a stiff elbow. ConclusionsOpen reduction and internal fixation using double plates in supracondylar humeral fractures obtains a high union rate allowing excellent functional and radiological outcomes.

Emerging U.S. National Trends in the Treatment of Pediatric Supracondylar Humeral Fractures.

Understanding national trends in the treatment of pediatric supracondylar humeral fractures will provide important insight into variations in regional treatment and identify areas for improving value and quality in care delivery in the U.S. U.S. national trends in the treatment of supracondylar humeral fractures were evaluated through query of the Humana (2007 to 2014) and ING (2007 to 2011) administrative claims databases. Geographic variation and changes in surgical and transfer rates over time were further explored through the Nationwide Emergency Department Sample (NEDS) database (2006 to 2011). Hospital characteristics impacting treatment decisions were identified. A total of 29,642 pediatric patients with supracondylar humeral fractures were identified in the administrative claims databases and a projected 63,348 encounters for supracondylar humeral fracture were identified in the NEDS database. The majority of the patients (76.1%; 22,563 of 29,642) were treated definitively with cast immobilization. Operative treatment was performed in 23.9% of the patients (7,079 of 29,642), with no change observed in the operative rate over time (p = 0.055). Of patients undergoing operative treatment, closed reduction and percutaneous pinning (CRPP) was performed in 87.3%, with a significant increase noted in the rate of CRPP over time (p = 0.0001); open reduction was performed in 12.7%, with a significant decrease noted in the rate of open reduction over time (p < 0.0001). Regional surgical rates generally showed significant variation from 2006 to 2010, followed by a convergence in the surgical rate among all geographic regions in 2011. These trends occurred simultaneous to a significant increase in transfer rates nationwide, from 5.6% in 2006 to 9.1% in 2011 (p = 0.0011). Transfer rates were significantly higher (p < 0.0001) for nontrauma, nonteaching, and nonmetropolitan centers while surgical rates were significantly higher (p < 0.0001) for trauma, teaching, and metropolitan centers when rates were analyzed by hospital designation. Operative treatment was performed in 24% of pediatric patients with supracondylar humeral fractures from 2007 to 2014. There was a convergence of surgical rates across geographic regions, suggesting that a "standard of care" in the treatment of supracondylar humeral fractures is being established nationally. Cases of pediatric supracondylar humeral fracture are increasingly being transferred to and, when managed surgically, receiving care at metropolitan facilities designated as trauma centers or teaching hospitals, with a corresponding decrease observed in the rate of open reduction. The optimization of nationwide referral and treatment patterns may improve value in care delivery.

Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3&lt;sup&gt;rd&lt;/sup&gt; and 9&lt;sup&gt;th&lt;/sup&gt; month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Limited open reduction with internal fixation versus closed reduction with external fixation in the treatment of irreducible supracondylar humerus fractures in children: an outcome comparison

Objective To compare the clinical results of treating irreducible supracondylar humerus fractures (Gartland type Ⅲ) in children with limited open reduction and internal fixation versus closed reduction with external fixator. Methods The clinical data of 34 pediatric patients who had been treated for supracondylar humerus fractures (Gartland type Ⅲ) from January 2012 to January 2014 were available for retrospective analysis. Eighteen patients were treated with limited open reduction via a limited medial or lateral incision followed by percutaneous Kirschner wire fixation (internal fixation group). The other 16 patients were treated with closed reduction followed by application of an external fixator (external fixation group). Surgery time, intraoperative radiography frequency, fracture healing time, the change of Baumann angle at 3 days and 2 months postoperatively, and elbow function were compared between the two groups. Results All the patients received a mean follow-up of 16.5 months (range, 12 to 24 months). Compared with the external fixation group, the internal fixation group needed significantly shorter average surgery time (49.1±6.6) minutes versus (72.3±12.6) minutes and significantly lower average intraoperative radiography frequency (3.6±0.9) times versus (10.1±2.0) times (P<0.05). All the fractures achieved clinical healing at 4 weeks postoperatively and bone union at 2 months postoperatively. The change of Baumann angle between 3 days and 2 months postoperatively was (2.4±1.3)° on average in the internal fixation group and (6.1±2.1)° on average in the external fixation group, with a significant difference (P<0.0001). Evaluation of elbow function using the Flynn elbow scoring system at 3 months postoperatively revealed a 27.8% (5/18) good to excellent rate in the internal fixation group and 25.0% (4/16) in the external fixation group. The good to excellent rate increased to 99.4% (17/18) in the internal fixation group and to 81.3% (13/16) in the external fixation group at 12 months postoperatively. There were no complications such as delayed union, compartment syndrome or iatrogenic lesions to vessels and nerves. Conclusion In the treatment of pediatric irreducible supracondylar humeral fractures (Gartland type Ⅲ), both limited open reduction with internal fixation and closed reduction with external fixation can lead to fracture healing within similar time. Limited open reduction with internal fixation can achieve more satisfactory reduction and more stable fixation, and can result in shorter operative time, lower intraoperative radiography frequency and better elbow function. Key words: Child; Fracture fixation, internal; External fixators; Supracondylar humerus fracture

Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children.

In this study, we aim to evaluate the clinical and radiological results of children who were treated with four different surgical approaches. In our clinics between February 2004 and November 2012, the children who underwent surgical treatment for supracondylar humeral fractures and whose data were available with regular follow-up of at least 1 year were included in the study. Clinical outcomes were evaluated for 54 patients with Gartland type 3 extension supracondylar fractures. Functional and cosmetic results of the patients were determined according to the Flynn criteria. Mean age of the patients was 4.9 (between 2 and 14) among which 26 of them were girls and 28 were boys. Mean operation time was 45 (35–85) min. Average length of hospital stay (LHS) was 2.9 (1–7) days. Average duration of splints was 3.5 (2–6) weeks, while the average removal period of the wires was 4.6 (3–8) weeks. Mean consolidation time was 4.6 weeks (3–8). Mean follow-up was 14.36 months. In our study, we performed 54 patients functional and cosmetic results. While 48 of the patients had satisfying results (excellent, good, or fair), six of them had unsatisfactory (poor) results. The results of this study suggest that clinical results with surgical treatment of Gartland type 3 extension fractures were satisfactory. However, the delay in the surgical treatment may cause a number of complications.

Supracondylar osteotomy for the treatment of cubitus varus in children: a systematic review.

Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other.

A new method to correct rotational malalignment for closed reduction and percutaneous pinning in pediatric supracondylar humeral fractures.

Open reduction is often necessary for the treatment of supracondylar humeral fractures in children in which rotational malalignment cannot be corrected by closed means. We introduce a new closed reduction technique for the correction of this deformity using a Kirschner wire as a joystick.

Behandlungsbedingte Schäden des N. radialis in der Kindertraumatologie

Iatrogenic damage of the N.ulnaris is a known complication of treatment of supracondylar humeral fractures in children. But damage to the N.radialis can also occur in the treatment of many typical fractures of the upper extremity during growth. There are no differentiated investigations on their incidence. This paper presents a prospective case collection and describes the personal experience with the occurrence and treatment of iatrogenic damage to the radial nerve during growth. In all 9 out of 20 cases occurred in the primary care setting, a further 9 under the metal removal and 2 on the occasion of corrective surgery. 50 % occurred after treatment of forearm shaft fractures, 39 % after distal-metaphyseal radius fractures, 11 % after radial neck fractures. In 80 % of the cases the sensory terminal branch was affected, in another 15 % the motor branch and in 5 % the main trunk of the nerve. The treatment of iatrogenic nerve damage should be cautious and restrained, spontaneous remissions, especially of pure sensory deficits, are common.