Flexion Supracondylar Humerus Fractures: Ulnar Nerve Deficit Is a Risk for Open Reduction

2018 ◽  
Author(s):  
Kelly R. Flynn ◽  
Research ◽  
Kelly Leddy ◽  
Christopher M. Brusalis ◽  
John M. Flynn
Keyword(s):  
Ulnar Nerve ◽  
Open Reduction ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

scholarly journals Study of Outcome of Open Reduction with Triceps Sparing Method in Paediatric Supracondylar Humerus Fractures

2016 ◽  
Vol 15 (07) ◽  
pp. 41-45
Author(s):  
Dr.Ravi Kiran.N ◽  
Dr.Sreenivasa Reddy ◽  
Dr.Reshma Kota ◽  
Dr.Saketh Kolla
Keyword(s):  
Open Reduction ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

scholarly journals Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

2018 ◽  
Vol 47 (1) ◽  
pp. 133-141
Author(s):  
Barak Rinat ◽  
Eytan Dujovny ◽  
Noam Bor ◽  
Nimrod Rozen ◽  
Guy Rubin
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Closed Reduction ◽  
Open Reduction ◽  
High Grade ◽  
Supracondylar Humerus Fractures ◽  
Long Term Follow Up ◽  
Humerus Fractures ◽  
Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

scholarly journals The role of ulnar nerve subcutaneous anterior transposition during open reduction and internal fixation of distal humerus fractures: a retrospective cohort study

2020 ◽  
Vol 44 (12) ◽  
pp. 2701-2708 ◽  
Author(s):  
Abdulaziz F. Ahmed ◽  
Ashik Mohsin Parambathkandi ◽  
Wai Jing Geraldine Kong ◽  
Motasem Salameh ◽  
Aiman Mudawi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Internal Fixation ◽  
Ulnar Nerve ◽  
Retrospective Cohort Study ◽  
Open Reduction ◽  
Retrospective Cohort ◽  
Distal Humerus ◽  
Anterior Transposition ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Abstract Purpose To compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures. Methods This was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery. Results Twenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00). Conclusion We do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.

scholarly journals Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mustafa Caner Okkaoglu ◽  
Fırat Emin Ozdemir ◽  
Erdi Ozdemir ◽  
Mert Karaduman ◽  
Ahmet Ates ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Open Reduction ◽  
Reduction Rate ◽  
Open Fractures ◽  
Night Time ◽  
Supracondylar Humerus Fractures ◽  
Duration Of Surgery ◽  
Humerus Fractures ◽  
Type 3 ◽  
Working Hour

Abstract Background We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference. Level of Evidence: Level 3, Retrospective cohort study

scholarly journals Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?

2021 ◽  
Author(s):  
Mustafa Caner Okkaoglu ◽  
Firat Emin Ozdemir ◽  
Erdi Ozdemir ◽  
Mert Karaduman ◽  
Ahmet Ates ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Open Reduction ◽  
Reduction Rate ◽  
Open Fractures ◽  
Night Time ◽  
Supracondylar Humerus Fractures ◽  
Duration Of Surgery ◽  
Humerus Fractures ◽  
Type 3 ◽  
Working Hour

Abstract Background:We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods:Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results:Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion:Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference.Level of Evidence: Level 3, Retrospective cohort study

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