A Rare Case of Pseudoaneurysm of the Brachial Artery in Supracondylar Humerus Fracture

Introduction: Supracondylar humerus fractures are very common fractures in children. About 10–14% are associated with vascular complications. We report a rare case of pseudoaneurysm of the brachial artery which was promptly detected in a well-perfused hand nearly 2 weeks after reduction and fixation. Case Report: A 10-year-old girl with Type I open supracondylar fracture of the left humerus (Modified Gartland Type 2) presented 2 weeks post-fixation with pulsatile mass in the elbow. Imaging revealed a pseudoaneurysm of brachial artery which was managed by excision and reconstruction using great saphenous vein graft. The fracture united uneventfully and the child made a full return to pre-fracture level of activity. Conclusion: The case highlights the occurrence of pseudoaneurysm of brachial artery, a rare complication seen few days or weeks after the injury, which coincides with the post-operative period in children managed by surgical fixation. This emphasizes the need for periodic monitoring of the neurovascular status of the children even after successful reduction and fixation. Keywords: Supracondylar humerus fracture, vascular complication, pseudoaneurysm.

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Is Percutaneous Fixation Necessary & Adequate For Displaced Supracondylar Fractures of Humerus in Children? - An Institutional Study

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0902.14 ◽

2021 ◽

Vol 9 (2) ◽

pp. 63-68

Author(s):

Vishal Pushkarna ◽

Vivek Patel

Keyword(s):

Retrospective Study ◽

Functional Results ◽

Humerus Fracture ◽

Type I ◽

Supracondylar Humerus Fracture ◽

Supracondylar Fractures ◽

Fair Result ◽

Fractures In Children ◽

Study Results ◽

Supracondylar Humerus Fractures

Supracondylar humerus fracture (SCHF) is frequently encountered in pediatric age group and nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilization with percutaneous pins. Aim: This retrospective study was conducted to find out the outcome and safety of percutaneous pinning techniques which includes lateral pinning and cross pinning in terms of functional and radiological outcome in the management of displaced supracondylar humerus fractures in children and to see the associated complications with this method of fixation. Materials & Methods: This retrospective study comprising of 40 cases of displaced supracondylar humerus fracture, treated with lateral or cross pinning was carried out at Orthopedics Department, Gujarat Adani Institute of Medical Sciences and G.K General Hospital, Bhuj from July 2019 to june2020. The inclusion criteria were: a) Gartland extension type II, III, b) age below 12 years, c) presented to OPD/Emergency within 48 hours of injury, d) closed and gustilo grade I open fractures, Patients with: a) extension Type I of fractures, b) flexion type injuries, c) except Gustilo grade 1 open fracture d) age more than 12 year e) pervious history of fractures or nerve injury around the elbow, were excluded from the study. Results: Out of the 40 patients, 25 (62.5%) were male and 15(37.5%) were female. The children were aged 2 years to 12 years with a median age of 7.67 years. There were 19 left sided and 21 right-sided fractures. 29 children had an injury while playing and 11 had a fall from a height. functional results in our study were 67.5% of cases had excellent results, 25% had good results, 5% had a fair result and 2.5% had a poor result. 75% of cases had excellent cosmetic results were 17.5% of cases had good results, 5% had fair result and only one case had a poor result. Conclusion: In our study, we found that anatomical reduction and intra- operative stability will dictate the type of configuration to be used in SCHF

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Pediatric brachial artery injury due to supracondylar humerus fractures: A case series

Vascular ◽

10.1177/1708538119851664 ◽

2019 ◽

Vol 27 (4) ◽

pp. 451-453 ◽

Cited By ~ 1

Author(s):

Courtney Grant ◽

Mark Theiss ◽

Dipankar Mukherjee

Keyword(s):

Brachial Artery ◽

Case Series ◽

Duplex Ultrasound ◽

Humerus Fracture ◽

Close Monitoring ◽

Supracondylar Humerus Fracture ◽

Surgical Exploration ◽

Artery Injury ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

Objectives Two to 20% of pediatric supracondylar humerus fractures present with abnormal vascular examinations ranging from ischemic hands to perfused pulseless hands. Management of perfused pulseless hands with observation or surgical exploration remains debatable. We report management and outcomes of five cases at our institution. Methods Charts of patients <18 years old with supracondylar humerus fractures undergoing brachial artery exploration from 2009 to 2016 were reviewed. Results Five patients presented with supracondylar humerus fracture after falls. Closed reduction and percutaneous pinning resulted in five pink hands, one with a palpable pulse and one with return of radial Doppler signal. Two were admitted for observation and one underwent immediate brachial artery exploration. The four cases initially managed non-operatively underwent exploration. Intraoperative findings included three brachial artery entrapments, one arterial compression due to hematoma, and one complete arterial transection requiring thrombectomy and venous interposition graft. At follow-up, all patients had palpable radial pulses. Conclusions Perfused pulseless hands after supracondylar humerus fracture reduction require close monitoring. Cases without return of radial Doppler signals should undergo immediate brachial exploration. We recommend duplex ultrasound for the diagnosis of brachial artery injury as an early guide to surgical exploration to prevent treatment delay and arm or hand ischemia.

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

10.21203/rs.3.rs-15966/v1 ◽

2020 ◽

Author(s):

Allieu Kamara ◽

Xianglu Ji ◽

Chuang Liu ◽

Tianjing Liu ◽

Enbo Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Preoperative Evaluation ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Element Analysis ◽

Bone Model ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Flexion Extension

Abstract Background : This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of crossed and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Method : Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed computationally. Various crossed and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results : Two-crossed pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-crossed pins were the most stable in all loading directions. The crossed pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-crossed pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion : In the fixation of extension-type, transverse supracondylar humerus fractures, 2-crossed pins are only superior to 2-divergent lateral pins in rotational loadings. Two-crossed pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-crossed pins however offer the best stability against both compression and rotation forces.This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

10.21203/rs.3.rs-15966/v2 ◽

2020 ◽

Author(s):

Allieu Kamara ◽

Xianglu Ji ◽

Chuang Liu ◽

Tianjing Liu ◽

Enbo Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Three Dimensional ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Element Analysis ◽

Bone Model ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Flexion Extension

Abstract Background: This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of cross and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Methods: Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results: Two-cross pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-cross pins were the most stable in all loading directions. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion: In the fixation of extension-type, transverse supracondylar humerus fractures, 2-cross pins are only superior to 2-divergent lateral pins in rotational loadings. Two-cross pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-cross pins however offer the best stability against both compression and rotation forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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A Rare Case of Median Nerve Entrapment within the Bone After Surgical Treatment of a Pediatric Supracondylar Humerus Fracture

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00059 ◽

2020 ◽

Vol 10 (3) ◽

pp. e20.00059-e20.00059

Author(s):

Gershon Zinger ◽

Sameh Abu Remeileh ◽

Alexander Bregman ◽

Genady Yudkevich

Keyword(s):

Surgical Treatment ◽

Median Nerve ◽

Rare Case ◽

Nerve Entrapment ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture

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Brachial Artery Pseudoaneurysm After Supracondylar Humerus Fracture

JBJS Case Connector ◽

10.2106/jbjs.cc.19.00218 ◽

2020 ◽

Vol 10 (1) ◽

pp. e0218-e0218

Author(s):

Sarah C. Tepper ◽

Caleb P. Gottlich ◽

Isam W. Nasr ◽

Paul D. Sponseller

Keyword(s):

Brachial Artery ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Artery Pseudoaneurysm

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Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues

Scandinavian Journal of Surgery ◽

10.1177/1457496920908770 ◽

2020 ◽

pp. 145749692090877

Author(s):

J. Hannonen ◽

T. Pokka ◽

W. Serlo ◽

J.-J. Sinikumpu

Keyword(s):

Surgical Technique ◽

Confidence Interval ◽

Kirschner Wire ◽

Surgical Techniques ◽

Humerus Fracture ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Entry Points ◽

Type 3

Background and Aims: Lateral-only Kirschner-wire pinning of supracondylar humerus fracture is superior in avoiding surgery-related ulnar nerve injury. Their disadvantageous effects on stability may be a consequence of inappropriate surgical techniques. We analyzed whether the surgeon’s preference for lateral-only fixation is associated with his or her orthopedic competence. We also analyzed the surgical technique–related risk factors of redisplacement. Materials and Methods: All children, aged <16 years, with a distal humerus fracture in 2000–2009 were preliminary included (N = 861). Altogether, 24 of the 165 type-3 supracondylar fractures were operated by lateral-only pinning. Loss of reduction in the follow-up was the main outcome, while the close characteristics of the surgical technique and treating surgeon’s orthopedic competence were the explanatory variables. Results: Orthopedic surgeons used lateral-only method in 23.5% of the type-3 fractures (N = 16/68), and other surgeons in 8.2% (N = 8/97)(difference = 15.3%, 95% confidence interval = 4.6%–27.6%, p = 0.005). One-third of the lateral-only treated fractures (29.2%, 95% confidence interval = 12.6%–51.1%) redisplaced. Lateral-entry pins that crossed at the level of the fracture were associated with failure (87.5%), while no patient with appropriate pin configuration failed (difference = 87.5%, 95% confidence interval = 52.1%–97.8%). A shorter distance (<5 mm) between the entry points of the pins was associated with redisplacement (80% vs. 15.8%, difference = 64.2%, 95% confidence interval = 16.1%–86.9%). Open reduction (p = 0.07), insufficient (<4 mm) bone contact (p = 0.28), monocortical pins (p = 0.569), low diverging angle (p = 0.13) or parallel pins (p = 1.0), residual coronal displacement (p = 1.0), >5° changed Bauman angle (p = 0.11), rotational displacement (p = 0.25), and the experience or specialty of the surgeon were not associated with redisplacement. Conclusion: Lateral-only pins resulted in poor stability in one in three of the patients. Appropriate configuration of the pins was associated with good fracture healing, but crossing the pins at the fracture level and introducing them close to each other were associated with redisplacement. Surgeons with more orthopedic competence selected lateral-only fixation more usually.

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Engineering Judgment of Children Bone Fracture

International Journal of Biomaterials ◽

10.1155/2011/737054 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

A. Alsamhan ◽

M. M. ELSingergy ◽

M. M. Zamzam ◽

S. M. Darwish

Keyword(s):

Finite Element ◽

Bone Fracture ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Finite Element Technique ◽

Fractures In Children ◽

Elbow Fractures ◽

Wire Fixation ◽

Element Technique

Supracondylar humerus fracture (SCHF) is one of the commonest elbow fractures in children. It is common injury for children with age from four to fourteen. In current study, the finite element technique is used to evaluate two techniques, namely, parallel and crossed K-wire fixation for treatment of SCHF, using K-wire fixation.

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Bilateral Supracondylar Humerus Fracture in Pediatric after a Fall on an Outstretched Hand

Case Reports in Orthopedics ◽

10.1155/2019/4893563 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Basam Alanazi ◽

Jameel Fakeeha ◽

Abdulrahman Pasha ◽

Hussam Alqulaiti ◽

Hani Alharbi ◽

...

Keyword(s):

Fracture Pattern ◽

Humerus Fracture ◽

Age Group ◽

Supracondylar Humerus Fracture ◽

Group Management ◽

Pediatric Age Group ◽

Outstretched Hand ◽

Supracondylar Humerus Fractures ◽

Surgical Fixation ◽

Group 5

Background. Supracondylar humerus fracture (SCH) is common in the pediatric age group 5-7 years, mostly due to a fall on an outstretched hand. However, a bilateral SCH is rarely observed in this age group. Management of SCH is either surgical or conservative based on the following factors: patient age, fracture pattern and neurovascular involvement. Complications of a displaced SCH can be dramatically reduced by early surgical fixation. Acute complications include: neurovascular injury and compartment syndrome, and long term complications include: stiffness, infections and angular deformities. In this article, we present a rare case of bilateral supracondylar humerus fractures with a six-months follow-up.

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