Management of comminuted supracondylar fractures of the humerus with closed reduction and a hybrid type Ml external fixator

2002 ◽  
Vol 15 (04) ◽  
pp. 233-239 ◽  
Author(s):  
R. D. Eaton-Wells ◽  
R. A. S. Mitchell ◽  
S. M. Fearnside
Keyword(s):  
Soft Tissue ◽  
Blood Supply ◽  
Bone Healing ◽  
External Fixator ◽  
Tissue Damage ◽  
Closed Reduction ◽  
Type I ◽  
Supracondylar Fractures ◽  
Hybrid Type ◽  
Supracondylar Humeral Fractures

SummaryClosed reduction and a hybrid type I-II external skeletal fixator (ESF) were utilised for the repair of comminuted supracondylar humeral fractures in seven dogs and two cats. The modified design of the ESF afforded significant flexibility in the management of these fractures, with closed reduction allowing the principles of biological osteosynthesis to be applied. Successful bone healing was achieved in eight cases. During implant removal, refracture occurred in one case. In comminuted supracondylar fractures of the humerus, where accurate fragment reduction is not feasible or where reconstruction may lead to further soft tissue damage and compromised blood supply to the bony fragments, the construct appeared to offer advantages, both mechanically and biologically, over other external fixator designs or bone plating. The design was used successfully in both large and small dog breeds and cats. The aim of this study is to report on the management and outcomes of comminuted supracondylar fractures managed using closed reduction and a hybrid type I-II ESF.

scholarly journals Three lateral divergent pinning for displaced supracondylar humerus fractures in children

2015 ◽  
Vol 1 (2) ◽  
pp. 30-34
Author(s):  
Rojan Tamrakar ◽  
Ramod Khanal ◽  
Balakrishnan M. Acharya ◽  
Nabees Man Singh Pradhan ◽  
Suman Kumar Shrestha
Keyword(s):  
Closed Reduction ◽  
Image Intensifier ◽  
Supracondylar Fractures ◽  
Stable Fixation ◽  
Fractures In Children ◽  
Loss Of Reduction ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures ◽  
Ulnar Nerve Injury

Introductions: Cross or two lateral pinnings are the most commonly done procedures for displaced supracondylar humerus fractures in children. A crossed pin is biomechanically stable than lateral pins, but associated with risk of iatrogenic ulnar nerve injury. Recent studies have shown stable fixation with three lateral pin construct. The purpose of this study was to evaluate the efficacy of three lateral divergent pinning for displaced supracondylar humerus fractures.Methods: Thirty five children with Gartland types III were treated between November 2012 and November 2013. Closed reduction and three lateral divergent pinning was done with image intensifier guidance. Patients were followed up for minimum 6 months. Radiological assessment was done to see union, proper pin placement and loss of reduction. Clinically, patients were assessed by using Flynn criteria.Results: There were 24 (68.6%) male and 11 (31.4%) female children between 2 to 13 years of age with displaced supracondylar fractures, left side 26 (74.3%) and right nine (25.7%) cases. All were successfully managed with closed reduction and three lateral divergent pins within 2-6 days of injury. One radial and one median nerve palsies sustained at injury recovered spontaneously. No iatrogenic nerve injuries occurred. A comparison of perioperative and final radiographs revealed no loss of reduction. Twenty-seven excellent, five good, two fair and one poor results on Flynn’s grading. One patient had a superficial pin-tract infection.Conclusions: Closed reduction with three lateral divergent pins is safe for stable fixation of displaced supracondylar humeral fractures in children.

FUNCTIONAL OUTCOME OF CLOSED DISPLACED SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN TREATED WITH CLOSED REDUCTION AND PERCUTANEOUS PINNING – A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 9-11
Author(s):  
Sandeep Ramola ◽  
Prasanth Srinivasan ◽  
Vidyanand M Makani
Keyword(s):  
Observational Study ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Prospective Observational Study ◽  
Supracondylar Fracture ◽  
Elbow Fracture ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Supracondylar Humeral Fractures ◽  
Carrying Angle

Background: Supracondylar humeral fractures are the most common fractures around elbow in children. The incidence is equal in both sexes with left or non-dominant side being most frequently injured. 96 to 98% are extension type and the exion type is far less common. Displaced supracondylar fractures are notorious for difculty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. Material and methods: A prospective observational study was conducted on sixty children with closed displaced supracondylar fracture of humerus treated with closed reduction and k wire xation, between May 2016 and June 2018. Children aged between 3 and 15 years, radiological nding conrming displaced supracondylar fracture of humerus were included in this study. Children with less than 3 years of age, physeal injury or intraarticular extension, open fractures, polytrauma of the same limb, previous fracture of the same elbow, fracture requiring open reduction and inability to give written informed consent were excluded in this study. All patients underwent closed reduction and percutaneous pinning within 24 hours of admission. The functional outcome was measured by the range of motion and carrying angle by using Flynn et al criteria. Results: Of 60 patients, 73.3% had excellent results, 18.3% had good, 5% had fair and 3.3% patients had poor results. Conclusion: Closed reduction and percutaneous pinning under C arm guidance is a simple and effective method of treatment of displaced supracondylar fractures of humerus in children with relatively fewer short term complications.

scholarly journals Management of supracondylar fractures of the humerus in children

2018 ◽  
Vol 3 (10) ◽  
pp. 526-540 ◽  
Author(s):  
Alfonso Vaquero-Picado ◽  
Gaspar González-Morán ◽  
Luis Moraleda
Keyword(s):  
Surgical Treatment ◽  
Ulnar Nerve ◽  
Closed Reduction ◽  
Type I ◽  
Supracondylar Fractures ◽  
Type Iv ◽  
Distal Pulse ◽  
Ulnar Nerve Injury ◽  
Almost All ◽  
Vascular Status

Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years. Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries. Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present. Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively. Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction. Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury. About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion. Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049

scholarly journals Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Joon-Woo Kim ◽  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh
Keyword(s):  
Closed Reduction ◽  
Humeral Fractures ◽  
Cubitus Varus ◽  
Supracondylar Fractures ◽  
Fixation Technique ◽  
Lateral Entry ◽  
Reduction Techniques ◽  
Fractures In Children ◽  
Loss Of Reduction ◽  
Supracondylar Humeral Fractures

Supracondylar humeral fractures are the most common injury of the elbow in children. Compared to flexion type fractures, extension type fractures are more common, up to 98%. Gartland classification has been used to guide the management of this injury, which is based on the extent of the displacement. If not adequately managed, completely displaced (type III) fractures may have a higher incidence of concomitant injury or complications, including neurovascular injury, compartment syndrome, or cubitus varus. Closed reduction followed by percutaneous pinning has been suggested as the standard operative method for the displaced supracondylar humeral fractures. However, these fractures can be challenging to reduce, with the traditional technique of closed reduction. Lateral-entry pinning is known as a sufficient method of fixation for this injury. However, the lateral pin only fixation technique may also result in loss of reduction in some particular patterns of fractures, such as fractures with medial column comminution. We discuss and describe the reduction techniques of completely displaced supracondylar humeral fractures, including technical tips and pitfalls for closed reduction and open reduction. We also discuss indications of medial pinning, and its safe method, when the lateral-entry pins may not achieve adequate stability.

scholarly journals Oral disorders in Chilean rodeo horses submitted for dental evaluation between 2010 and 2013

2016 ◽  
Vol 4 (3) ◽  
Author(s):  
Sebastian Guerra ◽  
Mario Pineda ◽  
Luis De Negri ◽  
Aiko Adell ◽  
Felipe Correa ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Confidence Intervals ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Statistical Significance ◽  
Age Groups ◽  
Type I ◽  
Premolar Extraction ◽  
Dental Diseases ◽  
Oral Examinations

Dental disorders are common in horses. The objetive of the study was determined the frequency of dental problems in Chilean Rodeo Horses and described the most common dental treatments used in Chile. Oral examinations were performed on 456 Chilean rodeo horses and the disorders were observed as follows: Oral soft tissues, 259 horses (56%) presented lacerations and/or ulcers. Regarding the first premolar, it was present in 32% of the horses, all maxillary positioned. In canines, 245 (54%) were present and overlong tooth. Disorders found in incisors show supererupted (Tooth overlong) in 147 (32%); ventral curvature in 116 (25%), nevertheless 102 (22%) horses showed no abnormalities. About the diseases found in cheek teeth (premolars and molars), the more prevalent ones was enamel points in 426 (93%), rostral or caudal hooks in 354 (78%), and ramps in 231 (51%). Confidence intervals between all dental diseases found in the study showed no statistical significance when was analyzed for age or gender. When age groups were made, statistical significance appear X² Pearson (p=0,01), were mostly malocclusion type I was the more common in young, mature and geriatric horses. Other disorders such as problems at the time of eruption, development and periodontal disease are statiscally similar X² (p=0,07). About the treatments it is important to mention that in 453 (99%) horses received odontoplasty and 147 (32%) first premolar extraction. This study shows that Chilean rodeo horses have dental disorders similar to other horse breeds, except by small increase in soft tissue damage and incisors problems.

Health-related quality of life after paediatric supracondylar humeral fractures

2020 ◽  
Vol 102-B (6) ◽  
pp. 755-765 ◽  
Author(s):  
Thoralf R. Liebs ◽  
Marie Burgard ◽  
Nadine Kaiser ◽  
Theddy Slongo ◽  
Steffen Berger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
External Fixator ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Related Quality ◽  
Health Related ◽  
Supracondylar Humeral Fractures

Aims We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP). Methods We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL). Results An AO type I SCHF was most frequent (327 children; type II: 143; type III: 150; type IV: 155 children). All children with type I fractures were treated nonoperatively. Two children with a type II fracture, 136 with a type III fracture, and 141 children with a type IV fracture underwent CRPP. In the remaining 27 children with type III or IV fractures, a lateral external fixator was necessary for closed reduction. There were no open reductions. After a mean follow-up of 6.3 years (SD 3.7), patients with a type I fracture had a mean QuickDASH of 2.0 (SD 5.2), at a scale of 0 to 100, with lower values representing better HRQoL (type II: 2.8 (SD 10.7); type III: 3.3 (SD 8.0); type IV: 1.8 (SD 4.6)). The mean function score of the PedsQL ranged from 97.4 (SD 8.0) for type I to 96.1 (SD 9.1) for type III fractures, at a scale of 0 to 100, with higher values representing better HRQoL. Conclusion In this cohort of 775 patients in whom nonoperative treatment was chosen for AO type I and II fractures and CRPP or a lateral external fixator was used in AO type III and IV fractures, there was equally excellent mid- and long-term HRQoL when assessed by the QuickDASH and PedsQL. These results indicate that the treatment protocol followed in this study is unambiguous, avoids open reductions, and is associated with excellent treatment outcomes. Cite this article: Bone Joint J 2020;102-B(6):755–765.

scholarly journals Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

2017 ◽  
Vol 18 (2) ◽  
pp. 145-150
Author(s):  
Branko Stefanovic ◽  
Zoran Vukasinovic ◽  
Srbobran Stankovic ◽  
Jovana Jeremic ◽  
Nevena Jeremic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Humeral Fractures ◽  
Type I ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Group I ◽  
Elbow Fractures ◽  
Retrospective Clinical Study ◽  
Supracondylar Humeral Fractures

AbstractSupracondylar humeral fractures (SCHF) are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I) is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III) of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4%) were boys and 17 (26.6%) were girls. The most common age range (59.4%) in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.Based on the results of the analysed parameters, consisting primarily of functional results, the absence of subjective symptoms and myositis ossificans one year after surgery suggests that emergency surgical treatment of displaced supracondylar humeral fractures is optimal.

scholarly journals Comparison of Outcome of Lateral K-Wire Fixation Verses Medio-Lateral Crossed K-Wire Fixation for Displaced Extension Type of Supracondylar Humeral Fractures in Children

2014 ◽  
Vol 2 (3) ◽  
pp. 20-25 ◽  
Author(s):  
HK Gupta ◽  
D Chaurasia
Keyword(s):  
Closed Reduction ◽  
P Value ◽  
Supracondylar Fractures ◽  
Lateral Entry ◽  
Pin Fixation ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Group A ◽  
Ulnar Nerve Injury ◽  
Group B

INTRODUCTION: Supracondylar humeral fractures are the most common elbow fractures seen in children. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of displaced extension supracondylar fractures of the humerus in children. MATERIAL AND METHODS: Total of 50 cases of displaced supracondylar fracture humerus were enrolled in study, 25 cases in two equal groups, Group A and group B. Group A received treatment by closed reduction with lateral k-wire fixation and Group B received treatment by closed reduction and medio-lateral k-wire fixation. The cases were followed at 4 weeks when slab was removed and physiotherapy started, and at 12 weeks for final outcome. The outcome was measured as per Flynn's criteria.RESULTS: The mean age of patents in group A was 6.40 years and in group B was 6.44 years. At final follow up, in group A, 18 (72%) cases had excellent, 7 (28%) good result, in group B; 20 (80%) had excellent, and 5 (20%) had good result. The p- value (0.08) derived between them was statistically not significant. Three pateints got superficial pin tract infection in group A and two iatrogenic ulnar nerve injury and one pin had pintract infection in group B. There were also no significant differences (p value- 0.697) between groups with respect to the baumann angle. CONCLUSION: Both lateral entry pin fixation and medio- lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children. Although there remains subtle risk of ulnar nerve injury in medio-lateral pin fixation.DOI: http://dx.doi.org/10.3126/jucms.v2i3.11823 Journal of Universal College of Medical Sciences Vol.2(3) 2014: 20-25

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