scholarly journals Application of ultrasound in the closed reduction and percutaneous pinning in supracondylar humeral fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yang Wu ◽  
Rongbin Lu ◽  
Shijie Liao ◽  
Xiaofei Ding ◽  
Wei Su ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Closed Reduction ◽  
Humeral Fractures ◽  
Elbow Fracture ◽  
Percutaneous Pinning ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Ultrasound Group

Abstract Background Ultrasound examination can be applied to the diagnosis of pediatric elbow fracture. This study aims to analyze the application value of ultrasound in the surgical treatment of supracondylar humeral fractures. Methods 64 children with supracondylar humeral fractures were treated with ultrasound-guided closed reduction and percutaneous pinning (CRPP), 31 patients were treated with CRPP under radiography guidence. The reduction effect of supracondylar humeral fractures was determined through the perioperative ultrasound images of the lateral, medial and posterior aspects of the elbow. Percutaneous pinning was performed after supracondylar humeral fractures were well reduced. A follow-up examination was performed and all the patients were evaluated according to Flynn’s criteria. Results The mean duration of surgery was 58.3 min (42–108 min) in the ultrasound group and 41.5 min (24-63 min) in the radiography group (P < 0.05). The mean carrying angle was 8.2° (0°–15°) in the ultrasound group and 9.4°(3°–16°) in the radiography group; The mean Baumann’s angle was 75.5°(60°–85°) in the ultrasound group and 73.4°(62°–82°) in the radiography group; The mean lateral humerocapitellar angle was 38.4° (26°–54°) in the ultrasound group and 41.6°(29°–52°) in the radiography group; No significant differences were observed between the two groups. According to the Flynn’s criteria, 49 (76.6%) patients had excellent, 10 (15.6%) patients achieved good, 3 (4.7%) patients showed fair results and 2 (3.1%) patients achieved poor results in the ultrasound group; 22 (70.9%) patients had excellent, 6 (19.4%) patients achieved good, 2 (6.5%) patients showed fair results and 1 (3.2%) patients achieved poor results in the radiography group; No statistically significant difference was noted between the results of these two groups (P > 0.05). After surgery, three patients had pin tract infection. One patient had ulnar nerve neurapraxia in the radiography group. No cases with Volkmann’s contracture were reported. Conclusion Ultrasound-guided CRPP is a safe and reliable surgical treatment of pediatric supracondylar humeral fractures. Trial registration Retrospectively registered.

scholarly journals Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng
Keyword(s):  
Brachial Artery ◽  
Closed Reduction ◽  
Duplex Ultrasound ◽  
Humeral Fractures ◽  
Percutaneous Pinning ◽  
Radial Pulse ◽  
Color Flow ◽  
Surgical Exploration ◽  
Close Observation ◽  
Supracondylar Humeral Fractures

Abstract Background The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. Methods Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function. Conclusions Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

scholarly journals Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng
Keyword(s):  
Brachial Artery ◽  
Closed Reduction ◽  
Duplex Ultrasound ◽  
Humeral Fractures ◽  
Percutaneous Pinning ◽  
Radial Pulse ◽  
Color Flow ◽  
Surgical Exploration ◽  
Close Observation ◽  
Supracondylar Humeral Fractures

Abstract Background: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand.Methods: Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function.Conclusion: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

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.

The Comparison of Postoperative Outcomes Open and Closed Reduction for Patellar Fractures

2018 ◽  
Vol 33 (01) ◽  
pp. 073-077
Author(s):  
Si Young Lee ◽  
Jun Young Choi ◽  
Hyun Il Lee ◽  
Jung Min Lee ◽  
Jin Ho Cho
Keyword(s):  
Surgical Treatment ◽  
Closed Reduction ◽  
Open Reduction ◽  
Visual Analog Scale Score ◽  
Significant Difference ◽  
Special Surgery ◽  
The Mean ◽  
Patellar Fractures ◽  
Postoperative Knee ◽  
Hospital For Special Surgery

AbstractPatellar fractures account for approximately 1% of all human body fractures. This study aimed to compare the surgical outcomes of open reduction and closed reduction for patellar fractures. This retrospective study included 62 patients (63 cases) who underwent surgical treatment of patellar fractures from 2008 to 2013. Of the 63 cases, open and closed reductions were performed in 42 and 21 cases, respectively. Plain radiography was used to assess fracture healing. Comminuted patellar fracture was the most common fracture type in both groups. Tension band wiring and cannulated screw fixation were mainly used in the open and closed reduction groups, respectively. There was no significant difference in the modified hospital for special surgery score, visual analog scale score for pain, and range of motion between the two groups. The mean union time was 3.2 and 3.0 months in open and closed reductions, respectively. Postoperative knee stiffness was noted in five cases of open reduction and in three cases of closed reduction. One patient in the open reduction group had a refracture. There were no notable differences in treatment outcomes between open and closed reductions. Thus, closed reduction may not be inferior to open reduction as a surgical treatment for patellar fractures.

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