Management of acute paediatric fractures treated surgically in the UK: a cross-sectional study

2021 ◽  
Author(s):  
MS Rashid ◽  
S Dorman ◽  
S Humphry ◽  
Keyword(s):  
National Standards ◽  
Humeral Fractures ◽  
Orthopaedic Trauma ◽  
Forearm Fractures ◽  
Supracondylar Fractures ◽  
Kirschner Wires ◽  
Radius Fractures ◽  
Supracondylar Humeral Fractures ◽  
Both Bones ◽  
Paediatric Orthopaedic

Introduction The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. Methods Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. Results Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. Conclusion Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.

scholarly journals Functional outcome of crossed Kirschner wire fixation in pediatric supracondylar humerus fracture

2019 ◽  
Vol 5 (5) ◽  
pp. 772
Author(s):  
Rahat Zahoor Moton ◽  
Adeel Ahmed Siddiqui ◽  
Muhammad Naseem ◽  
Uzair Yaqoob ◽  
Syed Amir Jalil ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Kirschner Wire ◽  
Humeral Fractures ◽  
Treatment Modalities ◽  
Class Iii ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures

<p class="abstract"><strong>Background:</strong> Distal humeral fractures are one of the most common types of fractures in children, most of them being supracondylar. Supracondylar fractures are usually caused by trauma, most likely falls. It is an emergency, requiring rapid diagnosis and management to avoid serious complications. Recommended treatment modalities vary from no reduction and immobilization to open reduction and internal fixation. Kirschner wire (K-wire) fixation of displaced supracondylar fractures after closed reduction is a preferred method and is being performed for over 50 years now. This study was conducted to determine the functional outcome of crossed K-wire fixation in pediatric supracondylar fracture.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted from May-November 2018 at the department of Orthopedics, Abbasi Shaheed Hospital, Karachi, Pakistan. It was inferred that functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation. It included 83 children with supracondylar fractures. They were treated with percutaneous crossed K-wire fixation. Patients were then followed up to determine satisfactory functional outcome according to Flynn’s criteria. Data entry and analysis was done using SPSS 21.0.</p><p class="abstract"><strong>Results:</strong> Eight-three patients were included. The mean±standard deviation age of this study population was 7.03±3.39 years. Out of the study participants, 47 (56.6%) were males and 36 (43.4%) were females. 71.1% of the patients were of Gartland class II fractures and 28.9% were of Gartland class III. 43.4% had an injury due to fall while playing while 19.3% had fallen from height. 80.7% were found to have a satisfactory functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.</p>

scholarly journals Paediatric supracondylar humeral fractures: the effect of the surgical specialty on the outcomes

2019 ◽  
Vol 13 (1) ◽  
pp. 40-46 ◽  
Author(s):  
A. J. Saarinen ◽  
I. Helenius
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Supracondylar Fractures ◽  
Level Of Evidence ◽  
Surgical Specialty ◽  
Orthopaedic Surgeons ◽  
Loss Of Reduction ◽  
Supracondylar Humeral Fractures ◽  
Pin Configuration

PurposeThe effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.MethodsA retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.ResultsResidents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).ConclusionWe found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.Level of evidence:Level III

scholarly journals COMPARISON OF TWO METHODS OF FIXATION OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

2021 ◽  
Vol 29 (5) ◽  
pp. 263-267
Author(s):  
HENRIQUE MELO NATALIN ◽  
JÉSSICA COLAMARINO SESSA DA SILVA ◽  
JOSÉ BATISTA VOLPON
Keyword(s):  
Kirschner Wire ◽  
Contralateral Side ◽  
Supracondylar Fractures ◽  
Kirschner Wires ◽  
Level Of Evidence ◽  
Results Of Treatment ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures ◽  
Carrying Angle ◽  
Therapeutic Study

ABSTRACT Objective: To compare the outcomes of the fixation of complete and displaced supracondylar humeral fractures in children with two different Kirschner wire configurations. Methods: The type of fixation was randomized to either crossed (19 cases), or two divergent lateral Kirschner wires (24 cases). The comparison was made six months later between the two treated groups and each group with the non-fractured elbow (clinical alignment, range of motion, Baumann angle, and lateral humeral capitellar angle). Results: 43 children were evaluated (65% boys) with a mean age of six years and five months. The carrying angle (p = 0.94), extension (p = 0.89), and the Flynn´s criteria (p = 0.56) were similar between the groups. The flexion was slightly smaller for the crossed wire group (p = 0.04), but similar to the uninjured side. The Baumann angle was not different between the two fixations (p = 0.79) and the contralateral side (p = 0.1). The lateral humeral capitellar angle was slightly greater for the lateral pinning (p = 0.08), but with no difference with the uninjured elbow (p = 0.62). No iatrogenic injuries were observed. Conclusion: Both fixations presented similar outcomes that did not significantly affect the carrying angle in relation to the non-fractured side. Level of evidence II, Therapeutic study - Investigating the results of treatment.

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 Osteosynthesis with Kirschner wires in the treatment of unstable forearm fractures in children

2002 ◽  
Vol 55 (3-4) ◽  
pp. 140-145 ◽  
Author(s):  
Dusan Maric ◽  
Lazar Petkovic ◽  
Vladimir Tomasevic ◽  
Ljubomir Bajic ◽  
Djordje Gajdobranski ◽  
...  
Keyword(s):  
Forearm Fractures ◽  
Percutaneous Pinning ◽  
Older Children ◽  
Kirschner Wires ◽  
Manual Reduction ◽  
Fractures In Children ◽  
Short Period ◽  
Both Bones ◽  
Plaster Immobilization ◽  
Unstable Fractures

Introduction Forearm fractures make 13-18% of all injuries of the upper extremities in children. Most of them are older than 6 years. The degree of tolerance is different but children younger than 8 years can tolerate 15-20 degrees of angulation, 45 degrees of inadequate rotation and total displacement. Older children can tolerate angulation of10 degrees, 30 degrees of in adequate rotation and complete dislocation. Material and methods Over a period of five years (1995-2000) 54 children with forearm fractures (22 stable and 32 unstable fractures) were treated at the Pediatric Surgery Clinic in Novi Sad. Closed reduction and percutaneous pinning were treatments of choice in 19 patients with unstable fractures: 7 kids with only radius pinning, three kids with isolated ulnar fixation, 9 kids with pinning of both bones. Open reposition and fixation with Kirschner wires was done in 13 kids. Results In the group of 22 children with stable fractures results were excellent in 17 (77%), good in 4 (18.5%), and satisfactory in one child (4.5%). In the group of 32 children with unstable fractures excellent results were noted in 24 (75%), good in 4 (12.5%) satisfactory in 3 (9.4%) and unsatisfactory in one child (3.1%) Discussion A large number of forearm fractures in children can be treated with manual reduction and plaster immobilization into a tolerable position. However, in unstable fractures the method of choice is manual reduction with percutaneous pinning. Some authors prefer fixation of both bones, others fix only one. Conclusions Based on our experience it is concluded that orthopedic reposition and percutaneous pinning of unstable forearm fractures in children is very easy to perform, duration of intramedullar fixation is relatively short, removal of pins is also very easy without anesthesia and it requires short period of plaster immobilization. This provides faster rehabilitation and improves quality of life.

scholarly journals Treatment of displaced flexion-type pediatric supracondylar humeral fractures in the prone position

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668441 ◽  
Author(s):  
Hsuan-Kai Kao ◽  
Wei-Chun Lee ◽  
Wen-E Yang ◽  
Chia-Hsieh Chang
Keyword(s):  
Prone Position ◽  
Open Reduction ◽  
Humeral Fractures ◽  
Radiographic Evaluation ◽  
Kirschner Wires ◽  
Safe Method ◽  
Supracondylar Humeral Fractures ◽  
Gentle Traction ◽  
The Mean ◽  
K Wires

Purpose: This study is to report a new method to reduce and fix the displaced flexion-type pediatric supracondylar fracture in the prone position. Methods: Ten children with displaced flexion-type supracondylar humeral fractures treated between 2007 and 2013 were reviewed. There were three girls and seven boys, with a mean age of 9.5 years. The fracture was reduced by gentle traction of the forearm and gradual extension of the elbow in the prone position. Two or three crossed Kirschner wires (K-wires) were inserted percutaneously to secure the fracture reduction. Radiographic evaluation included the Baumann’s angle and the lateral humerocapitellar angle. Clinical outcomes were assessed using the Flynn’s criteria. Results: Eight children had closed reduction and percutaneous K-wire fixation. The other two children required open reduction through a posterior triceps splitting approach. The mean Baumann’s angle was 70.2° immediately after K-wires fixation and 69.5° after 3 months later. The mean lateral humerocapitellar angle was 38° immediately after K-wires fixation and 35.5° after 3 months later. The clinical outcome was excellent in nine children and poor in one child by the Flynn’s criteria. Conclusion: Reduction of displaced flexion-type pediatric supracondylar humeral fractures by traction and gradual extension in the prone position is an effective and safe method. When reduction is still impossible or nerve incarceration is suspected, open reduction and release of the trapped nerve through a posterior triceps splitting approach are simply accessible.

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 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.

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