scholarly journals Subcapital phalangeal fractures in children: A retrospective review

2021 ◽  
Vol 28 ◽  
pp. 221049172110355
Author(s):  
Grady Maddox ◽  
Claire Levek ◽  
Ryan Caldwell ◽  
Uriel Villalobos ◽  
William Madry ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Retrospective Review ◽  
Closed Reduction ◽  
Open Reduction ◽  
Sagittal Plane ◽  
Open Reduction Internal Fixation ◽  
Distal Fragment ◽  
Percutaneous Pinning ◽  
Surgical Group ◽  
Delay In Treatment

Introduction: Phalangeal neck fractures represent a subset of pediatric hand injuries which pose challenges to the treating physician. The aim of this study was to understand which radiographic or clinical variables were associated with the need for closed reduction and percutaneous pinning or were associated with the need for open reduction internal fixation. Methods: A retrospective review was performed on pediatric patients treated for subcapital phalangeal neck fracture of the middle or proximal phalanx between 2009 and 2014. Non-operative and operative groups (open reduction internal fixation, closed reduction percutaneous pinning) compared displacement and angulation of the distal fragment at the time of initial injury, displacement, and angulation of the distal fragment at the time of final follow-up, mechanism of injury, delays in treatment, time to union, and rate of complications. Results: One hundred seventy seven patients met eligibility criteria for the review. Average age was 9.1 years for the surgical group and 8.5 years for the non-surgical group. Time to union was significantly higher for the surgery group (53 vs 30 days, p < 0.001). The degree of sagittal plane translation and sagittal angulation were predictive factors for surgical treatment. Sagittal plane angulation was higher in the surgical group (26.5° vs 9°, p < 0.001). A delay in treatment with subsequent surgery was not predictive of a need for open reduction internal fixation over closed reduction percutaneous pinning ( p = 0.19). Final sagittal angulation was corrected to a median of zero, an eight degree difference from the non-surgical group ( p = 0.002). Conclusions: This study demonstrates that a strong correlation between initial sagittal plane angulation and a need for surgery. A longer time to union and decreased range of motion may be expected in patient's requiring operative intervention. Delay in treatment was not associated with open reduction over closed reduction percutaneous pinning within the surgical group.

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Tyler W. Henry ◽  
Jacob E. Tulipan ◽  
Stephanie A. Kwan ◽  
Pedro K. Beredjiklian ◽  
Kevin F. Lutsky ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Open Reduction Internal Fixation ◽  
Complication Rates ◽  
Percutaneous Pinning ◽  
Full Extension ◽  
Extensor Lag

Background Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. Methods All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. Results Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. Conclusions Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.

scholarly journals Comparison of outcome of closed reduction and percutaneous pinning and, open reduction and internal fixation with k-wire in Gartland extension type III supracondylar fracture of distal humerus in pediatric population

2018 ◽  
Vol 1 (1) ◽  
pp. 1-3
Author(s):  
Bhogendra Bahadur KC ◽  
Norman Lamichhane ◽  
Chandra Bahadur Mishra ◽  
Bharat Bahadur Khatri ◽  
Sabita Dhakal
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Open Reduction ◽  
Operative Procedure ◽  
Distal Humerus ◽  
Supracondylar Fracture ◽  
P Value ◽  
Percutaneous Pinning ◽  
Type Iii

Background: Supracondylar fracture of the distal humerus is one of the commonest fracture in pediatric age group. Though there is consensus of treating type III fracture operatively, no study has compared the outcome between Closed Reduction and Percutaneous Pinning (CRPP) and Open Reduction and Internal Fixation (ORIF) with k-wire in our setup. Materials and Methods: Retrospective comparison study was done on eighty seven cases of Type III supracondylar fracture of distal humerus underwent operative procedure. Fifty four (54) cases underwent CRPP and 33 cases were managed with ORIF with k-wire, and they were followed up till 6 months post-operatively. Results : The mean time for radiological union in patient who underwent CRPP was 4.37±0.94 weeks and that for the patient who underwent ORIF was 4.45±0.13 weeks, the difference of which was statistically insignificant (p-value >0.05). 83.3% of CRPP group and 78.8% in ORIF group had excellent functional outcome and only 3% in ORIF group had poor functional outcome. Conclusion: Though both the group don’t have significant advantage of functional outcome among each other CRPP with limited attempt should be preferred to ORIF with k-wire for the advantage of avoiding surgical scar and reducing surgery time and exposure to anaesthetic agents.

scholarly journals Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Vol 21 (1) ◽  
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 ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 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 is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. 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 min. 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.

scholarly journals Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by > 4 mm: an observational cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Juan Wang ◽  
Xin Liu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Postoperative Treatment ◽  
Therapeutic Effects ◽  
Type I ◽  
Percutaneous Pinning ◽  
Cubitus Varus ◽  
Humerus Fractures

Abstract Background Although open reduction and internal fixation (ORIF) is recommended for lateral condylar humerus fractures (LCHFs) displaced by > 4 mm, several studies have reported the use of closed reduction and percutaneous pinning (CRPP) to treat LCHFs with significant displacement. However, little is known about the clinical differences between these two surgical techniques. This study aimed to compare the therapeutic effects of CRPP and ORIF in treating LCHFs displaced by > 4 mm. Methods We retrospectively reviewed pediatric LCHFs displaced by > 4 mm treated with either CRPP or ORIF at our center from June 2019 to October 2020. Song and Milch fracture classifications were used. Variables such as age at injury, sex, side injured, fracture displacement, fracture type, operating time, postoperative treatment, and complications were compared between the two techniques. Results One hundred twenty LCHFs met inclusion criteria. There were 36 Milch type I and 84 type II LCHFs, and 69 Song stage 4 and 51 stage 5 LCHFs. CRPP was performed in 45 cases and ORIF in 75 cases. No differences were found in age, sex, side injured, preoperative displacement, postoperative displacement, and length of immobilization between the CRPP and ORIF groups. There was a difference between operation time and pin duration. The CRPP group had shorter operation times and pin duration, and required no additional operations to remove internal pins. The average follow-up duration was 13.9 months. All patients achieved fracture union, and no complications such as infection, nonunion, delayed union, osteonecrosis, fishtail deformity, cubitus varus or valgus, or pain were recorded during follow-up. Bone spurs, lateral prominences, and decreased carrying angle were common complications in all groups. No obvious cubitus varus was observed. Unaesthetic scars were only observed in the ORIF groups. No differences in range of motion or elbow function was found among the different therapies. Conclusions Both CRPP and ORIF can achieve satisfactory clinical outcomes in treating LCHFs displaced by > 4 mm. No differences were found in complications or prognoses between the two groups. However, CRPP shows some advantages over ORIF, like less invasive surgery, no obvious scarring, and no need for secondary surgery with anesthesia for pin removal.

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