Nonunion Following Subcapital (Neck) Fractures of the Proximal Phalanx of the Thumb in Children

1999 ◽  
Vol 24 (6) ◽  
pp. 693-698 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
E. CARDOSO ◽  
J. HASSANAIN ◽  
M. B. HAWARY ◽  
N. NANDAGOPAL ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Bone Grafts ◽  
Limited Range ◽  
Interphalangeal Joint ◽  
Mechanism Of Injury ◽  
Fractures In Children ◽  
Wire Fixation

Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.

Temporary Use of Skeletal Traction in Management of Pediatric Supracondylar Humeral Fractures

2020 ◽  
Vol 22 (6) ◽  
pp. 427-436
Author(s):  
Piotr Zając ◽  
Piotr Zając
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Treatment Algorithm ◽  
Vascular Complications ◽  
Humeral Fractures ◽  
Percutaneous Fixation ◽  
Skeletal Traction ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures

Background. The paper presents a treatment algorithm for supracondylar humeral fractures in children, involving temporary use of skeletal traction following failure of primary closed reduction and percutaneous fixation (CRPF) and introducing closed reduction after management by skeletal traction. The aim of this study was to assess the outcomes of supracondylar humerus fracture treatment performed according to the algorithm. Material and methods. The treatment was performed in 149 children (70 girls, 79 boys) with extension-type supracondylar humeral fractures. The study group was assessed with regard to a modified Gartland classification, neurological complications (12 children, 8%) and vascular complications (8 children, 5.4%). A total of 124 (83.2%) patients underwent emergency CRPF and 24 children (16.1%) received skeletal traction after a failed CRPF. After 2-6 days, an elective repeat CRPF procedure was attempted, which was successful in 17 children. The attempt failed in the other 7 children, who received traction and underwent open reduction under a single anesthesia. One child (0.7%) with a white and pulseless hand was treated by emergency open reduction and percutaneous fixation. Results. The study used the Flynn criteria modified by the author. After 6 months, the results in the group treated with CRPF (both primary and following skeletal traction) were good in 90.8% of patients, satisfactory in 8.5%, and poor in 0.7%, whereas in the open reduction and percutaneous fixation group, the results were good in 87.5% of cases and satisfactory in 12.5%. Conclusions. 1. X-ray-guided closed reduction and percutaneous K wire fixation is a method of choice in the treatment of displaced supracondylar humeral fractures in children. If closed reduction fails, the surgeon is faced with a choice between primary open reduction and the use of direct traction through the olecranon. 2. The use of skeletal traction following failure of primary emergency CRPF results in local improvement in the fracture region and allows for scheduling an elective repeat delayed closed reduction and percutaneous K wire fixation procedure. 3. The algorithm used in clinical practice, based on literature reports and the author’s experience, helps achieve good treatment outcomes.

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

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.

Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint: A Comparative Study of Percutaneous Kirschner Wire Fixation Versus Open Reduction and Internal Fixation

2005 ◽  
Vol 30 (2) ◽  
pp. 120-128 ◽  
Author(s):  
A. ALADIN ◽  
T. R. C. DAVIS
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Cerclage Wire ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Nineteen patients with a dorsal fracture–dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

Long-Term Evaluation of Bennett’s Fracture

1994 ◽  
Vol 19 (3) ◽  
pp. 373-377 ◽  
Author(s):  
E. J. F. TIMMENGA ◽  
T. J. BLOKHUIS ◽  
M. MAAS ◽  
E. L. F. B. RAAIJMAKERS
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Bennett’S Fracture ◽  
Wire Fixation ◽  
Term Evaluation ◽  
Restricted Mobility ◽  
Almost All

18 patients with Bennett’s fracture were evaluated after a mean follow-up period of 10.7 years. Treatment consisted of closed reduction and K-wire fixation in seven cases and open reduction with osteosynthesis in 11 cases. Overall, symptoms were few and restricted mobility of the thumb could not be demonstrated. The strength of the affected hand was decreased in all patients regardless of the type of treatment. Osteoarthritis was found to correlate with the quality of reduction of the fracture, but had developed in almost all cases even after exact reduction. Exact reduction, either by the open or closed method, should be the aim of treatment of Bennett’s fracture.

A Prospective Randomized Controlled Study of Fixation of Long Oblique and Spiral Shaft Fractures of the Proximal Phalanx: Closed Reduction and Percutaneous Kirschner Wiring Versus Open Reduction and Lag Screw Fixation

2003 ◽  
Vol 28 (1) ◽  
pp. 5-9 ◽  
Author(s):  
T. C. HORTON ◽  
M. HATTON ◽  
T. R. C. DAVIS
Keyword(s):  
Grip Strength ◽  
Closed Reduction ◽  
Open Reduction ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Controlled Study ◽  
X Rays ◽  
Lag Screw ◽  
Significant Difference

Patients with an isolated spiral or long oblique fracture of the proximal phalanx were randomized into two groups. One was treated by closed reduction and Kirschner wire fixation and the second treated by open reduction and lag screw fixation. An independent observer assessed function, pain, movement, grip strength and intrinsic muscle function. X-rays were assessed for malunion. Thirty-two patients were entered the study and 15 in the Kirschner wire and 13 in the lag screw group were reviewed at a mean follow-up of 40 months. There was no significant difference in the functional recovery rates or in the pain scores for the two groups. X-rays showed similar rates of malunion and there were no statistically significant differences in range of movement or grip strength.

scholarly journals Open Reduction of Supracondylar Humerus Fractures in Children for Failed Closed Reduction: Outcome of Delayed Treatment

2021 ◽  
Vol 53 (3) ◽  
pp. 143-147
Author(s):  
Yoyos Dias Ismiarto ◽  
◽  
Mahyudin ◽  
Adriel Benedict Haryono
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Early Group ◽  
Supracondylar Fractures ◽  
Delayed Treatment ◽  
Type Iii ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Supracondylar Humerus Fractures

Supracondylar fractures of the humerus are common in children and the advocated treatments for these fractures include closed reduction and percutaneous pinning. There are numerous debates on the intervention period selection for delayed treatment in children. This phenomenon is prevalent in regions with limited healthcare support. The objective of this study was to compare the outcome of early and late treatment groups, including preliminary presentations and the management of failed treatment. This was a prospective comparative study on early and late open reduction, featuring Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 18 years. Patients from January 2018 to January 2019 were categorized into early and late groups (n=22 and n=26), consisting of 33 (86.8%) males and 15 (31.25%) females. Flynn’s criteria were used to evaluate them. The average time from injury to surgery was 50.24±23.5 hours in the early group and 373.79±89.23 hours in the late group (p<0.002). While the Bauman’s angle recorded after 12 weeks presented the values of 82.04 ± 5.18 and 77.38±6.43 (p=0.622) for the early and late groups, respectively. Pre-operative nerve injuries were observed only in 4 (8.33%) cases from the early group. The functional outcomes of both categories were not significantly different statistically (p=0.242). The outcome for children with supracondylar humerus fracture Gartland type III was satisfactory in both groups. In conclusion, treatment delay does not result in a difference in the outcome according to Flynn's criteria.

scholarly journals Efficacy and complications after delayed fixation of femoral neck fractures in children

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901988968 ◽  
Author(s):  
Chunxing Wu ◽  
Bo Ning ◽  
Ping Xu ◽  
Jun Song ◽  
Dahui Wang
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Open Reduction ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Fractures In Children ◽  
Reduction Group ◽  
Time From Injury

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

Irreducible Compound Dorsal Dislocations of the Proximal Interphalangeal Joint of the Finger

1986 ◽  
Vol 11 (1) ◽  
pp. 49-50
Author(s):  
INGER KJELDAL
Keyword(s):  
Soft Tissue ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Probable Mechanism ◽  
Hand Injuries ◽  
Tissue Structures

Three cases of compound irreducible dorsal dislocation of the proximal interphalangeal joint of the finger are reported. The probable mechanism is discussed. The findings warrant the description “volar capsular boutonnière” as the condyles of the proximal phalanx buttonhole, through the volar structures. Open reduction combined with debridement, is the treatment for such compound irreducible dorsal dislocations. Dislocation of the proximal interphalangeal joints of the fingers are common and can usually be reduced by simple traction. Occasionally reduction by closed methods is unsuccessful because of interposition of volar or dorsal soft tissue structures (Lamb 1981). This study reports three cases of compound dorsal dislocation of the proximal interphalangeal joint with volar soft tissue interposition. Such lesions are sparsely mentioned in text books on fractures and hand injuries and hitherto only a few cases have been published (Lamb 1981, Bunnell 1956).

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