Deformity and functional outcome after treatment for supracondylar humerus fractures in children: a 5- to 10-year follow-up of 139 supracondylar humerus fractures treated by plaster cast, skeletal traction or crossed wire fixation

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

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Dislocated Extension – Type Supracondylar Humerus Fractures in Children: Single Centre Experience

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.005 ◽

2014 ◽

Vol 2 (1) ◽

pp. 29-33

Author(s):

Lazar Todorovic ◽

Mile Petrovski ◽

Aco Dimov ◽

Riste Simeonov ◽

Marjan Kamiloski ◽

...

Keyword(s):

Supracondylar Fractures ◽

Cubitus Valgus ◽

Fractures In Children ◽

Number Of Patients ◽

Single Centre Experience ◽

Supracondylar Humerus Fractures ◽

Supracondylar Humeral Fractures ◽

Humerus Fractures

Aim: The aim of this study is to show our experience in cases of dislocated extension type – supracondylar humeral fractures and evaluate the results of their treatment in the period from 2000 to 2010 with a follow up of a maximum six months.Material and Methods: A retrospective analysis of the clinical cases for the period 2000 – 2010 was done. Children from 4 to 14 years of age with supracondylar fractures of the humerus – extension type are included. The total number of patients treated at the Clinic for Pediatric Surgery was 230.Results: The results of the treatment were evaluated after the last control examination six months later. We noticed postoperative neurological damage in 10 cases (4.85%). In 14 patients (6.8%) we noticed long term deformities such as cubitus varus or cubitus valgus. Infection at the entering place of the needles occurred in 4 patients (1.94%), which did not indicate premature extraction of the needles and conversion of the treatment.Conclusion: As a conclusion, we can stress that our outcomes in treatment of dislocated suparacondylar fractures of the humerus in children meet the world standards.

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Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200130 ◽

2020 ◽

Vol 14 (6) ◽

pp. 495-501

Author(s):

Justin J. Ernat ◽

Robert L. Wimberly ◽

Christine A. Ho ◽

Anthony I. Riccio

Keyword(s):

Functional Outcome ◽

Outcome Measures ◽

Level Of Evidence ◽

Vascular Abnormality ◽

Supracondylar Humerus Fractures ◽

Palpable Pulse ◽

Humerus Fractures ◽

Functional Outcome Measures ◽

A Prospective Study

Purpose This article prospectively examines the functional outcome measures following management of vascular insult secondary to paediatric supracondylar humerus fractures (SCHFX) using validated outcome measures. Methods The three-year, prospective, IRB-approved study consecutively enrolled operative SCHFX patients. Clinical data included presence and symmetry of the radial pulse in injured and uninjured extremities, Doppler examination of non-palpable (NP) pulses and perfusion status of the hand. Pediatric Outcomes Data Collection Instruments (PODCI) and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Measures were used to assess functional outcome at final follow-up. Multiple regression analysis was used to determine the relationship between the presence of a vascular abnormality and functional outcome while controlling for other injury parameters. Results A total of 146/752 enrolled patients (mean age 6.8 years; range 2 years to 13 years) completed functional outcome measures at final follow-up. Of these, 20 (14%) patients had abnormal vascular exams at presentation: nine (6%) with palpable asymmetric pulse and 11 (7.5%) with NP pulse. Of those with NP pulses, nine/11 (6%) were Dopplerable and two (1.5%) lacked identifiable Doppler signal. Patients with a symmetric, palpable pulse demonstrated better PODCI pain and comfort scores (95.2 versus 85.2) (p < 0.0001), and QuickDASH scores (10.9 versus 21.6) (p < 0.007) compared to those with any abnormal vascular examination. Patients with palpable pulses, regardless of symmetry, demonstrated significantly higher PODCI pain and comfort scores (94.6 versus 84.7) (p < 0.003) than NP pulses. Conclusions In children with operative SCHFX, an abnormal vascular examination at presentation is predictive of poorer outcomes in pain and upper extremity function. A palpable pulse, versus NP, is predictive of better pain and comfort at final follow-up. Level of evidence II

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Percutaneous K-wire Fixation Of Supracondylar Humerus Fractures In Children - Techniques To Minimise Occurrence Of Ulnar Nerve Injuries Through Experiments On Sheep.

The Internet Journal of Surgery ◽

10.5580/111e ◽

2000 ◽

Vol 1 (2) ◽

Keyword(s):

Ulnar Nerve ◽

Nerve Injuries ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Humerus Fractures

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Parent and Patient Satisfaction after Treatment for Supracondylar Humerus Fractures in 139 Children: No Difference between Skeletal Traction and Crossed Pin Fixation at Long-Term Followup

Advances in Orthopedics ◽

10.1155/2012/958487 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Sven Young ◽

Jonas M. Fevang ◽

Gunnar Gullaksen ◽

Per T. Nilsen ◽

Lars B. Engesæter

Keyword(s):

Patient Satisfaction ◽

Analogue Scale ◽

Skeletal Traction ◽

Treatment Groups ◽

Pin Fixation ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Choice Of Treatment ◽

Humerus Fractures

Aim. The aim of this study was to see whether the benefits of crossed wire fixation over skeletal traction in the treatment of pediatric supracondylar humerus fractures (SCHF) were mirrored in the children's or their caregivers' rating of the experience.Methods. As part of a study of the clinical outcome of SCHF, all the patients and the parents were asked to rate their experience of the treatment on a visual analogue scale (VAS).Results. There was no difference in the patients' or the parents' experience between the treatment groups. However there was a difference between the parents with children who experienced a neurovascular complication (mean VAS 6.1) and those that did not (mean VAS 4.3, ). The boys rated the experience as less negative (mean VAS 3.6) than the girls (mean VAS 4.7, ).Conclusion. In the long term, avoiding complications was more important to the parents than the choice of treatment for SCHF in the children.

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