scholarly journals “DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Gheorghe Burnei ◽  
Ionuţ Răducan ◽  
Florin-Daniel Enache ◽  
Adriana Dărăban ◽  
Cecilia Avram ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
San Antonio ◽  
Plaster Cast ◽  
Experimental Program ◽  
Supracondylar Fractures ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Elbow Pathology

Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery. Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.

scholarly journals “Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

2021 ◽  
Author(s):  
Gheorghe Burnei ◽  
Ionut Daniel Răducan ◽  
Florin-Daniel Enache ◽  
Adriana Maria Dărăban ◽  
Cecilia Roberta Avram ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
San Antonio ◽  
Plaster Cast ◽  
Experimental Program ◽  
Medial Approach ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Background Context

Abstract Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001–2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982–2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery.

scholarly journals SUPRACONDYLAR HUMERUS FRACTURES

2011 ◽  
Vol 18 (01) ◽  
pp. 147-153
Author(s):  
NOOR AKBAR SIAL ◽  
ABID RASHID ◽  
AJMAL YASIN
Keyword(s):  
Open Reduction ◽  
Kirschner Wire ◽  
University Hospital ◽  
Supracondylar Fractures ◽  
Medical College ◽  
Pin Fixation ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Grade Ii

Displaced Supracondylar fractures of the humerus in children are common injuries treated by orthopaedic surgeons. Objectives: To evaluate the role of open reduction and percutaneous crossed pin fixation in displayed supracondylar fractures and to design a simple and effective protocol for the treatment of these fractures. Design: Prospective. Setting: Independent Medical College Independent University Hospital Faisalabad. Period: From January 2009 to June 2010. Method: Fifty six cases with grade II and grade III Gartland Supracondylar humeral fractures were treated with open reduction through postereomedial approach and percutaneous crossed pin fixation with Kirschner wire and followed up for a minimum period of 1 year. Results: Patients were assessed on the basis of Flynn’s criteria there were 41 Excellent and12 good results Conclusions: It is concluded that open reduction and percutaneous crossed pin fixation is a sound and effective treatment for displayed supracondylar fractures with several advantages but requires careful judgment on the part of surgeon to avoid complications.

scholarly journals Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

2016 ◽  
Vol 4 (1) ◽  
pp. 28
Author(s):  
Rajeev Dwivedi ◽  
Ruban Raj Joshi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Treatment ◽  
Functional Results ◽  
Supracondylar Fracture ◽  
Supracondylar Fractures ◽  
Radiological Criteria ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Mean Time

Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.   Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.   Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.   Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

scholarly journals Management of supracondylar fracture humerus type 3 in children with percutaneous K-wire vs. open reduction and internal fixation with K-wire

2017 ◽  
Vol 4 (1) ◽  
pp. 120
Author(s):  
Shaik Md Waseem Ahmed ◽  
R. Biju
Keyword(s):  
Internal Fixation ◽  
Ulnar Nerve ◽  
Closed Reduction ◽  
Open Reduction ◽  
Reduction Technique ◽  
P Value ◽  
Supracondylar Fractures ◽  
Ulnar Nerve Palsy ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Aim of the study is to determine the relation between the reduction technique percutaneous pinning and open reduction and internal fixation with K-wire used in management of supracondylar humerus fractures in paediatric age group and the ultimate elbow status (functional and cosmetic), so that appropriate reduction technique can be adopted for better functional and cosmetic outcome.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Children below 12 years with Gartland’s type III supracondylar fractures managed by closed reduction and percutaneous K-wire fixation and open reduction and K-wire fixation and Flynn’s criteria was used to grade the outcome of surgical fixation. 10 Closed reduction and K-wire fixation and 10 open reduction and K-wire fixation were done</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Most of the fractures were sustained when the patient had fallen down on out stretched hand while playing or slip and fall. According to Flynn’s grading, there are 7 excellent, 2 good and 1 fair functional result observed in closed reduction and k wire fixation. There are 4 excellent, 3 good and 3 fair functional results observed in open reduction and k wire fixation with statistically significant p value 0.04</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Open reduction through lateral approach and internal fixation wire K wires is safe and effective method of treatment, if indicated, in supracondylar fractures of humerus in children and is associated with a good outcome. A small incision medially in cases where medial epicondyle cannot be defined to visualize the epicondyle and the ulnar nerve, by which iatrogenic ulnar nerve palsy in percutaneous fixation can be prevented.</span></p>

scholarly journals The role of open reduction and internal fixation in the treatment of the intercondylar fractures of humerus

2019 ◽  
Vol 5 (5) ◽  
pp. 855
Author(s):  
Venkata Sivaram G. V. ◽  
Y. V. S. Prabhakar
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Early Mobilization ◽  
Distal Humerus ◽  
Inclusion Criteria ◽  
Senior Faculty ◽  
Chevron Osteotomy ◽  
Stiff Elbow ◽  
Condylar Fractures

<p class="abstract"><strong>Background:</strong> Inter-condylar fractures represent one of the most complicated and challenging fractures in the upper extremity. The results of managing these fractures non-operatively are limited by failure to get anatomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudo-arthrosis. The objective of this study was to evaluate and analyse the role of open reduction and internal fixation in inter-condylar fractures of distal humerus.</p><p class="abstract"><strong>Methods:</strong><strong> </strong>The present study was done in Malla Reddy Institute of Medical Sciences between June 2014 and June 2017. Out of 34 cases of intercondylar fractures of humerus admitted during the period, 25 patients were selected for the study that satisfied our inclusion criteria. Three patients out of those selected could not be included in the study as one had cardiac issues pre-operatively, one refused surgery and one was lost to follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study included 22 patients, 14 male and 8 female patients. Their average age was 41.4 years. The fractures were classified as per the AO classification. There were B1-3, B2-1, C1-6, C2-5, C3-7 fractures. Both compound and closed fractures were included. All the patients were operated by posterior olecranon Chevron osteotomy approach by a senior faculty member. Twenty two patients who satisfied our inclusion criteria were treated, followed up and the results analyzed using Cassabaum’s scale of elbow function we had 86% of excellent to good results. Our results are comparable with other similar studies.</p><p class="abstract"><strong>Conclusions:</strong> Posterior olecranon approach was found to be of most satisfactory approach by us. It allows good exposure of the joint and the ulnar nerve.</p>

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.

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