Functional and radiographic outcomes of Gartland type II supracondylar humerus fractures managed by closed reduction under nitrous oxide as conscious sedation

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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Emergency room closed reductionversus in situsplinting in the treatment of paediatric supracondylar humerus fractures

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190018 ◽

2019 ◽

Vol 13 (3) ◽

pp. 334-339 ◽

Cited By ~ 1

Author(s):

S. M. Sylvia ◽

K. J. Maguire ◽

D. A. Molho ◽

B. J. Levens ◽

M. E. Jr. Stone ◽

...

Keyword(s):

Closed Reduction ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Type Ii ◽

Continuous Variables ◽

Level Of Evidence ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Humerus Fractures

PurposeDisplaced supracondylar humerus fractures are treated with open or closed reduction and percutaneous pinning. In 2012, our management of patients with a displaced fracture changed from closed reduction in the emergency department (ED) to in situ splinting prior to closed reduction and pinning in the operating room (OR). The purpose of this study was to investigate if outcomes or complications differ between these two management methods.MethodsPatients less than ten years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Radiographic outcomes were assessed at follow-up. The Fisher’s exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables.ResultsIn all, 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared with those treated with reduction (16 hours versus 22 hours, p < 0.005) and a shorter hospital length of stay (34 hours versus 40 hours, p < 0.005).ConclusionNo difference in complications or outcomes was found between patients with Type II or III supracondylar fractures treated initially with or without closed reduction in the ED. Patients treated without ED reduction were taken to the OR sooner and remained in the hospital for a shorter period of time. Splinting in situ reduces anaesthesia exposure without increasing postoperative complications or suboptimal outcomes.Level of EvidenceLevel III, retrospective comparative study

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Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

Journal of International Medical Research ◽

10.1177/0300060518797022 ◽

2018 ◽

Vol 47 (1) ◽

pp. 133-141

Author(s):

Barak Rinat ◽

Eytan Dujovny ◽

Noam Bor ◽

Nimrod Rozen ◽

Guy Rubin

Keyword(s):

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Closed Reduction ◽

Open Reduction ◽

High Grade ◽

Supracondylar Humerus Fractures ◽

Long Term Follow Up ◽

Humerus Fractures ◽

Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

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Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

Journal Of The Indonesian Medical Association ◽

10.47830/jinma-vol.71.4-2021-389 ◽

2021 ◽

Vol 71 (4) ◽

pp. 187-193

Author(s):

Putu Astawa ◽

Made Agus Maharjana ◽

Surya Adisthanaya ◽

Made Winatra Satya Putra ◽

Agus Suarjaya Putra ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Meta Analysis ◽

Fixed Effect Model ◽

Cosmetic Outcome ◽

Type I ◽

Type Ii ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Humerus Fractures

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.

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Supracondylar Humerus Fractures in Older Children: Success of Closed Reduction and Percutaneous Pinning

OrthoMedia ◽

10.1302/3114-220968 ◽

2022 ◽

Keyword(s):

Closed Reduction ◽

Percutaneous Pinning ◽

Older Children ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

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Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures

Medicina ◽

10.3390/medicina55080450 ◽

2019 ◽

Vol 55 (8) ◽

pp. 450

Author(s):

Turhal ◽

Kınaş ◽

Karaduman ◽

Turhan ◽

Kaya ◽

...

Keyword(s):

Surgical Treatment ◽

Closed Reduction ◽

Lateral Entry ◽

Chondral Damage ◽

Supracondylar Humerus Fractures ◽

Cosmetic Outcomes ◽

Humerus Fractures ◽

The Mean ◽

Type 3 ◽

Adhesive Bandage

Background and objectives: Supracondylar humerus fractures are common in children andcan be surgically treated. However, the general surgical procedures involving reduction andfixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desiredposition, prolonged surgery, or chondral damage. This study aimed to show that temporaryfixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerusfractures could maintain reduction so that surgical treatment can be easily performed by a singlephysician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerusfractures who underwent surgical treatment between May 2017 and June 2018 were retrospectivelyevaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of theforearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pinswere applied on the fracture line by first inserting a lateral-entry K-wire and then inserting anotherK-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nervetunnel. A tourniquet was not applied in any patient and no patients required open reduction.Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years).The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks,respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia wasdetected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes wereexcellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation ofthe closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration ofpinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerusfractures that require surgical treatment with a fabric adhesive bandage may be significantlyconvenient in practice.

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Is the “Appropriate Use Criteria” for Type II Supracondylar Humerus Fractures Really Appropriate?

Journal of Pediatric Orthopaedics ◽

10.1097/01241398-900000000-98716 ◽

2018 ◽

pp. 1

Author(s):

Mauricio Silva ◽

Edward Ebramzadeh

Keyword(s):

Type Ii ◽

Appropriate Use Criteria ◽

Appropriate Use ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

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Pediatric Type II Supracondylar Humerus Fractures

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001693 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Vaibhav Jain ◽

Prateek Behera ◽

John A. Santoshi ◽

Virendra K. Verma ◽

Manoj Nagar

Keyword(s):

Type Ii ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

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One-year follow up of pediatric supracondylar humerus fractures with bone fragments

10.21203/rs.2.17771/v1 ◽

2019 ◽

Author(s):

Lei Yang ◽

Lang Li ◽

Panyi Yang ◽

Xueyang Tang

Keyword(s):

Clinical Outcome ◽

Range Of Motion ◽

Closed Reduction ◽

X Ray ◽

Supracondylar Humerus Fractures ◽

Bone Fragments ◽

Humerus Fractures ◽

The Mean ◽

Carrying Angle ◽

One Year

Abstract Background The aim of this study is to evaluate the clinical and imaging outcome of pediatric supracondylar humerus fractures with bone fragments on X ray film after closed reduction and percutaneous pin fixation.Methods A retrospective review of 12 children with fragments on image after closed reduction treatment for displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included the outcome of the fragments, post-operative Baumann angle, Carrying angle and loss of reduction. The clinical outcome included elbow range of motion, Flynn grade and other complications.Results Totally there were 460 cases of pediatric supracondylar humerus fractures (2-14 years old) treated in our center from January 2015 to January 2018, and 12 (2.6%) of the patients with bone fragments on postoperative X ray film were included. All 12 patients had bone fragments union or absorbed at 1 year after operation with good radiographic and clinical outcome. The mean Baumann angle was 15.5±4.3°, and the mean Carrying angle was 11.2±2.8°. All patients had a normal elbow range of motion, 10 patients obtained an excellent result, and 2 patients were good According to Flynn criteria. Conclusions We have good results for closed reduction and percutaneous pin fixation treatments in 12 pediatric supracondylar humerus fractures with bone fragments. The fragments were mainly absorbed or union to humerus in one year after surgery.

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