scholarly journals Late Deep Infections Complicating Percutaneous Pinning of Supracondylar Humerus Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Achraf H. Jardaly ◽  
Ketrick LaCoste ◽  
Shawn R. Gilbert ◽  
Michael J. Conklin
Keyword(s):  
Closed Reduction ◽  
Late Complications ◽  
Percutaneous Pinning ◽  
Institutional Review ◽  
Fractures In Children ◽  
Irrigation And Debridement ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures ◽  
One Year

Objectives. Complications following treatment of supracondylar humerus fractures are typically seen shortly postoperatively. Late complications occurring years after percutaneous pinning are rare but can be indolent and have permanent sequelae. We present cases of children presenting with late deep infections to discuss their diagnosis and treatment. Methods. After institutional review board approval, we retrospectively reviewed records of three children who developed deep infections at least one year after percutaneous pinning of their supracondylar humerus fracture. Patient details and outcomes were analyzed. Radiographs and magnetic resonance imaging were reviewed along with each patient’s clinical course and treatment. Results. We report 3 cases of osteomyelitis and/or septic arthritis presenting at least one year after supracondylar humerus fractures treated with closed reduction and percutaneous pinning. The patients required several irrigation and debridement procedures with placement of antibiotic beads in addition to a prolonged course of antibiotics. Conclusion. Delayed deep infections can occur after closed reduction and percutaneous pinning of supracondylar humerus fractures in children. Vigilance is required to diagnose and treat such occurrences, and prolonged follow-up is needed to monitor for recurrent or intractable infections.

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.

scholarly journals Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

2018 ◽  
Vol 12 (5) ◽  
pp. 502-508 ◽  
Author(s):  
R. M. Thompson ◽  
E. W. Hubbard ◽  
M. Elliott ◽  
A. I. Riccio ◽  
D. J. Sucato
Keyword(s):  
Postoperative Complications ◽  
Clinical Findings ◽  
Late Complications ◽  
Percutaneous Pinning ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Clinic Appointment ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

PurposePostoperative protocols following surgical management of supracondylar humerus fractures (SCFs) are often based upon surgeon preference rather than clinical merit. The purpose of this study is to determine the utility of early clinical and radiographic follow-up.MethodsA retrospective review of patients who underwent closed reduction and percutaneous pinning (CRPP) for SCF between 2009 and 2015 was performed using a database of prospectively-collected consecutive patient data. Previously undiagnosed neuropathies documented at the first postoperative visit were identified. Unscheduled visits and postoperative complications were compared between patients who were seen at one week and those with delayed first clinic visits.ResultsOf 873 patients, 823 (94.3%) were seen within ten days of surgery (early follow-up) and 50 (5.7%) had a delayed first clinic appointment. Among patients seen for early follow-up, 12 (1.5%) had a previously undocumented neuropathy diagnosed but only eight (1%) had an alteration of management secondary to clinical findings. Greater than 90% of patients seen for early follow-up had radiographs performed, but only one had an alteration in management due to radiographic findings. Patients seen for early follow-up had the same rate of unscheduled visits (2.9% versus 4%, p = 0.66) and postoperative complications (1.6% versus 0%, p > 0.99) as those with delayed first appointments. Radiographic parameters were comparable at final follow-up (Baumann’s angle 74.5° versus 73.7°, p = 0.40; lateral humeral condylar angle 40.2° versus 41.2°, p = 0.53).ConclusionThe early follow-up visit after CRPP of SCF rarely leads to alterations in care and does not reduce unscheduled visits or late complications.Level of EvidenceLevel IV

scholarly journals Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Fractures In Children ◽  
Humerus Fractures

Abstract Background: Lateral condylar humerus fractures (LCHFs) are the second most common fractures in children. Open reduction and internal fixation is recommended for fractures displaced by more than 4 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction and fixation are necessary to ensure a fracture gap less than 2.0 mm both on anteroposterior view and oblique internal rotational view by fluoroscopy. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

Supracondylar humerus fractures in children treated with closed reduction and percutaneous pinning

2012 ◽  
Vol 96 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Michelangelo Scaglione ◽  
Daniele Giovannelli ◽  
Luca Fabbri ◽  
Dario Dell’Omo ◽  
Andrea Goffi ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Percutaneous Pinning ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

Complications and Timing of Follow-up After Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures

2004 ◽  
Vol 24 (6) ◽  
pp. 610-614 ◽  
Author(s):  
Brent A. Ponce ◽  
Daniel J. Hedequist ◽  
David Zurakowski ◽  
Carol C. Atkinson ◽  
Peter M. Waters
Keyword(s):  
Closed Reduction ◽  
Percutaneous Pinning ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures
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