Open Reduction and Internal Fixation of Displaced Supracondylar Fractures of the Humerus in Children

1976 ◽  
Vol 7 (3) ◽  
pp. 573-581 ◽  
Author(s):  
Peter G. Shifrin ◽  
Harold W. Gehring ◽  
Louis J. Iglesias
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Supracondylar Fractures

scholarly journals Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

2016 ◽  
Vol 4 (1) ◽  
pp. 28
Author(s):  
Rajeev Dwivedi ◽  
Ruban Raj Joshi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Treatment ◽  
Functional Results ◽  
Supracondylar Fracture ◽  
Supracondylar Fractures ◽  
Radiological Criteria ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Mean Time

Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.   Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.   Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.   Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

scholarly journals “DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Gheorghe Burnei ◽  
Ionuţ Răducan ◽  
Florin-Daniel Enache ◽  
Adriana Dărăban ◽  
Cecilia Avram ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
San Antonio ◽  
Plaster Cast ◽  
Experimental Program ◽  
Supracondylar Fractures ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Elbow Pathology

Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery. Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.

scholarly journals Type-III supracondylar humerus fracture: functional outcome of open reduction and internal fixation after failed closed reduction

2020 ◽  
Vol 7 (1) ◽  
pp. 62
Author(s):  
Shobha H. P. ◽  
Vishwas K. ◽  
Lingaraju K. ◽  
Giridhar Kumar
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Supracondylar Fractures ◽  
Orthopaedic Department ◽  
Type Iii ◽  
Medical College ◽  
K Wires ◽  
Age Range

<p><strong>Background: </strong>To evaluate results of open reduction and internal fixation with Criss cross k-wires after failed closed reduction in Gartland type III Supracondylar fracture of humerus in our institution.<strong></strong></p><p><strong>Methods:</strong> This prospective study was conducted at the Krishna Rajendra hospital affiliated to the orthopaedic department of Mysore medical college and research institute from December 2018 to December 2019. Twenty-five patients of type-III fracture of supracondylar humerus were included within the study. Consent was obtained from all patients. Under anaesthesia, closed reduction was attempted first. When 2-3 attempts of closed reduction failed, an open reduction and internal fixation with cross k-wires was performed. Fortnightly follow up was applied for the first 8 weeks then monthly for the next 4 months. The clinical outcome was evaluated using Flynn criteria.</p><p><strong>Results:</strong> Out of 25 patients, 16 were male and 9 were female. Left side was involved in 17 patients and right side in 8. Mean age was 6.9 years with age range from 3 to 12 years. Excellent or good results were obtained in 23 (92%) patients and fair or poor in 2 (8%). </p><p><strong>Conclusions:</strong> We conclude that these fractures must be managed aggressively, by a specialised surgeon. Open reduction and internal fixation of severely displaced supracondylar fractures of the humerus is a safe and effective method when a satisfactory reduction can't be obtained by 2-3 attempts on closed method.</p>

scholarly journals Management of Displaced Supracondylar Fracture of Late Presentation in Children by Open Reduction and Internal Fixation

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 745-749
Author(s):  
Md Ashraful Islam ◽  
Md Abdur Rashid ◽  
Md Hafizur Rahman Milon ◽  
Mohammed Solayman ◽  
Md Asmaul Hossain Khan
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Late Presentation ◽  
Supracondylar Fracture ◽  
Control Group ◽  
Joint Motion ◽  
Supracondylar Fractures ◽  
Kirschner Wires ◽  
Average Delay ◽  
Multicentric Study

Background: In late presentation of cases there is dilemma whether to wait for osteotomy later or do open reduction on arrival. The purpose of this prospective multicentric study is to evaluate the functional outcome of open reduction and internal fixation (ORIF) with crossed Kirschner wires fixation and early joint motion in the late presentation of supracondylar fractures in children.Methods: A total of 21 children, with an average delay of 22.5 days, with displaced type III Gartland supracondylar fracture, were treated by ORIF with crossed Kirschner wires fixation and early joint motion. Average follow-up was 12 months.Results: Flynn's criteria were used to evaluate the outcome. All of them had more functional range of motion of the injured elbow than the published reports.Conclusions: Most of the surgeons in the developing world prefer ORIF for optimal results. Thus it appears to be justifiable to go for ORIF with K-wires even in the late presentation of supracondylar fractures. The overall results are encouraging. However, the small number of cases and lack of control group are the limitations of this study. The study is ongoing and so the full report with more cases will be presented later.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 745-749

scholarly journals Management of supracondylar fracture humerus type 3 in children with percutaneous K-wire vs. open reduction and internal fixation with K-wire

2017 ◽  
Vol 4 (1) ◽  
pp. 120
Author(s):  
Shaik Md Waseem Ahmed ◽  
R. Biju
Keyword(s):  
Internal Fixation ◽  
Ulnar Nerve ◽  
Closed Reduction ◽  
Open Reduction ◽  
Reduction Technique ◽  
P Value ◽  
Supracondylar Fractures ◽  
Ulnar Nerve Palsy ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Aim of the study is to determine the relation between the reduction technique percutaneous pinning and open reduction and internal fixation with K-wire used in management of supracondylar humerus fractures in paediatric age group and the ultimate elbow status (functional and cosmetic), so that appropriate reduction technique can be adopted for better functional and cosmetic outcome.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Children below 12 years with Gartland’s type III supracondylar fractures managed by closed reduction and percutaneous K-wire fixation and open reduction and K-wire fixation and Flynn’s criteria was used to grade the outcome of surgical fixation. 10 Closed reduction and K-wire fixation and 10 open reduction and K-wire fixation were done</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Most of the fractures were sustained when the patient had fallen down on out stretched hand while playing or slip and fall. According to Flynn’s grading, there are 7 excellent, 2 good and 1 fair functional result observed in closed reduction and k wire fixation. There are 4 excellent, 3 good and 3 fair functional results observed in open reduction and k wire fixation with statistically significant p value 0.04</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Open reduction through lateral approach and internal fixation wire K wires is safe and effective method of treatment, if indicated, in supracondylar fractures of humerus in children and is associated with a good outcome. A small incision medially in cases where medial epicondyle cannot be defined to visualize the epicondyle and the ulnar nerve, by which iatrogenic ulnar nerve palsy in percutaneous fixation can be prevented.</span></p>

scholarly journals Functional and radiological outcome after closed reduction and percutaneous pinning versus open reduction and internal fixation in displaced supracondylar fractures in children

2016 ◽  
Vol 19 (2) ◽  
pp. 21-27 ◽  
Author(s):  
Amin Kumar Shrestha ◽  
Suresh Uprety ◽  
Govinda K.C. ◽  
Sharma Paudel
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Supracondylar Fracture ◽  
Age Group ◽  
Radiological Outcome ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Significant Difference ◽  
The Mean

Introduction: Supracondylar fracture of humerus is very common fracture in pediatric age group. The current trends of management in displaced type are close reduction and per cutaneous pinning (CRPP), if reduction is not satisfactory then open reduction and internal fixation (ORIF) is done.  Our study aims to compare the cosmetic, functional and radiological outcome between these two methods. Methodology: Children with displaced extension type supracondylar fracture of distal humerus presenting to emergency room and orthopedics OPD who could meet the inclusion criteria were taken up for study. Sixty-three such patients (37 CRPP and 26 ORIF) were included in the study. Radiological and functional outcomes were followed up at 8 weeks post-operatively. Results: Of the 63 patients enrolled, 26 (41.3%) patients had undergone open reduction and internal fixation and 37 (58/7%) had undergone close reduction and percutaneous pinning. The mean age of patients in CRPP and ORIF groups was 7.29±2.3 years and 8.11±2.02 years respectively. Maximum patients were from age group 7-9 years (46%). Left side was more commonly injured (66.7% vs. 33.3%) (P = 0.045). According to the Flynn’s criteria, cosmetically the outcome did not differ between the two surgical groups (P = 0.23). However, CRPP proved to have a significantly better functional outcome (P=0.000). The mean Bauman’s angle in CRPP and ORIF groups was 16.89±5.66 and 18.88±4.90 degrees respectively. However, there is no statistically significant difference between the type of fixation and Bauman’s angle or Anterior humeral line. Conclusions: Close reduction and percutaneous pinning (CRPP) has better functional and radiological outcome in comparison with open reduction and internal fixation (ORIF) in displaced supracondylar fracture of humerus in children.

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