scholarly journals Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

2019 ◽  
Vol 5 (6) ◽  
pp. 1202
Author(s):  
Mohamad Gouse ◽  
Manoharan Muthulingam ◽  
Nandakumar Rangarajan
Keyword(s):  
Functional Outcome ◽  
Closed Reduction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Early Mobilization ◽  
Functional Results ◽  
Type Ii ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures

<p class="abstract"><strong>Background:</strong> Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.</p><p class="abstract"><strong>Methods:</strong> 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.</p><p><strong>Conclusions:</strong> From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness. </p>

scholarly journals Open Reduction of Supracondylar Humerus Fractures in Children for Failed Closed Reduction: Outcome of Delayed Treatment

2021 ◽  
Vol 53 (3) ◽  
pp. 143-147
Author(s):  
Yoyos Dias Ismiarto ◽  
◽  
Mahyudin ◽  
Adriel Benedict Haryono
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Early Group ◽  
Supracondylar Fractures ◽  
Delayed Treatment ◽  
Type Iii ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Supracondylar Humerus Fractures

Supracondylar fractures of the humerus are common in children and the advocated treatments for these fractures include closed reduction and percutaneous pinning. There are numerous debates on the intervention period selection for delayed treatment in children. This phenomenon is prevalent in regions with limited healthcare support. The objective of this study was to compare the outcome of early and late treatment groups, including preliminary presentations and the management of failed treatment. This was a prospective comparative study on early and late open reduction, featuring Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 18 years. Patients from January 2018 to January 2019 were categorized into early and late groups (n=22 and n=26), consisting of 33 (86.8%) males and 15 (31.25%) females. Flynn’s criteria were used to evaluate them. The average time from injury to surgery was 50.24±23.5 hours in the early group and 373.79±89.23 hours in the late group (p<0.002). While the Bauman’s angle recorded after 12 weeks presented the values of 82.04 ± 5.18 and 77.38±6.43 (p=0.622) for the early and late groups, respectively. Pre-operative nerve injuries were observed only in 4 (8.33%) cases from the early group. The functional outcomes of both categories were not significantly different statistically (p=0.242). The outcome for children with supracondylar humerus fracture Gartland type III was satisfactory in both groups. In conclusion, treatment delay does not result in a difference in the outcome according to Flynn's criteria.

scholarly journals Three lateral divergent pinning for displaced supracondylar humerus fractures in children

2015 ◽  
Vol 1 (2) ◽  
pp. 30-34
Author(s):  
Rojan Tamrakar ◽  
Ramod Khanal ◽  
Balakrishnan M. Acharya ◽  
Nabees Man Singh Pradhan ◽  
Suman Kumar Shrestha
Keyword(s):  
Closed Reduction ◽  
Image Intensifier ◽  
Supracondylar Fractures ◽  
Stable Fixation ◽  
Fractures In Children ◽  
Loss Of Reduction ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures ◽  
Ulnar Nerve Injury

Introductions: Cross or two lateral pinnings are the most commonly done procedures for displaced supracondylar humerus fractures in children. A crossed pin is biomechanically stable than lateral pins, but associated with risk of iatrogenic ulnar nerve injury. Recent studies have shown stable fixation with three lateral pin construct. The purpose of this study was to evaluate the efficacy of three lateral divergent pinning for displaced supracondylar humerus fractures.Methods: Thirty five children with Gartland types III were treated between November 2012 and November 2013. Closed reduction and three lateral divergent pinning was done with image intensifier guidance. Patients were followed up for minimum 6 months. Radiological assessment was done to see union, proper pin placement and loss of reduction. Clinically, patients were assessed by using Flynn criteria.Results: There were 24 (68.6%) male and 11 (31.4%) female children between 2 to 13 years of age with displaced supracondylar fractures, left side 26 (74.3%) and right nine (25.7%) cases. All were successfully managed with closed reduction and three lateral divergent pins within 2-6 days of injury. One radial and one median nerve palsies sustained at injury recovered spontaneously. No iatrogenic nerve injuries occurred. A comparison of perioperative and final radiographs revealed no loss of reduction. Twenty-seven excellent, five good, two fair and one poor results on Flynn’s grading. One patient had a superficial pin-tract infection.Conclusions: Closed reduction with three lateral divergent pins is safe for stable fixation of displaced supracondylar humeral fractures in children.

scholarly journals Comparison of closed reduction and percutaneous cross verses parallel k wire fixation in supracondylar fractures of the humerus in children.

2020 ◽  
Vol 27 (03) ◽  
pp. 476-480
Author(s):  
Farhan Majeed ◽  
Mudasser Saddique ◽  
Hafiz Nasir ◽  
Ahmad Shams
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Closed Reduction ◽  
Functional Results ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Group A ◽  
Ulnar Nerve Injury ◽  
K Wires

Around the elbow, supracondylar injury of humerus is one of the conventional fractures which usually occurs at the age of 7 to 8 years. Various conservative techniques have been used for the management, which comprises of the splintage, tractions, open or closed reduction with k wire fixation. However, closed reduction and percutaneous pinning remains the mainstay of surgical management, for they have shown splendid outcomes according to many authors. Objectives: The aim of this study is to summarise and compare the radiological and functional results of two ways of fixation (cross and parallel closed K wires) of supracondylar fractures in children. Study Design: Randomized controlled trial. Setting: Department of Orthopaedics Surgery, Services Hospital, Lahore. Period: 1st January 2018 to 31st June 2018. Material & Methods: We included 180 patients (90 in each group). Results: The mean age was 6.45±2.34 years with 115(63.9%) male and 65(36.1%) female. Among the children who underwent fixation with cross k-wires, ulnar nerve injury was seen in 2(2.2%) cases and none were seen in the other group post operatively. Group A attained higher union rate at last follow up. 4(4.4%) cases in Cross K-wires and 19(21.1%) in two lateral k-wires gave outstanding outcome. In a nutshell, 60 in group A and 45 in group B showed excellent outcomes based on Flynn's criteria, p-value < 0.05. Conclusion: According to Flynn’s criteria, closed percutaneous cross K-wire fixation of supracondylar fracture of humerus is an effective management option in terms of finer functional results as compared to Parallel k-wires. Although, the rate of radiological union is higher in cross k-wire fixation, there are 2.2% chances of ulnar nerve injury.

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

scholarly journals Study of percutaneous K wire fixation in supracondylar fracture of humerus in children

2019 ◽  
Vol 5 (3) ◽  
pp. 427
Author(s):  
Putappa Gopinath ◽  
Sabneet Singh ◽  
Abdul Ravoof
Keyword(s):  
Functional Outcome ◽  
Closed Reduction ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Anatomical Reduction ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Carrying Angle ◽  
Loss Of Motion

<p class="abstract"><strong>Background:</strong> Closed reduction is difficult not only to achieve but also to maintain because of the thinness of bone of the distal humerus between the coronoid and olecranon where most supracondylar fractures occurs. For this reason percutaneous pinning techniques have become the treatment of choice for most supracondylar fractures. By this procedure even the displaced and rotated fracture can be treated successfully with minimal incidence of complications. The purpose of this study is to determine the efficacy of management of displaced supracondylar fractures using closed reduction with percutaneous K-wire pinning and to analyze the results, loss of carrying angle, and loss of motion with incidence of complications.</p><p class="abstract"><strong>Methods:</strong> 20 cases of displaced supracondylar fractures in children aged between 5 and 12 years were treated by closed reduction and percutaneous pinning and were studied prospectively for functional outcome. 8 cases were treated with crossed pinning. 11 cases were treated with 3K wire fixation and 1 with lateral pinning.<strong></strong></p><p class="abstract"><strong>Results:</strong> 85% of the patients observed excellent results. 15% of the patients observed fair results. Of the cases treated by 3K wire fixation 55% had excellent results and cases with crossed pinning 40% had good results and 5% had poor results. All the patients treated with lateral pinning had excellent results.</p><p class="abstract"><strong>Conclusions:</strong> The results obtained in this study shows that anatomical reduction by closed method and stabilization with K-wire fixation is the first treatment of choice for displaced supracondylar fractures.</p>

scholarly journals Supracondylar fracture humerus (Gartland Type III) managed with closed reduction and percutaneous pinning (CRPP) in children.

2020 ◽  
Vol 27 (06) ◽  
pp. 1092-1096
Author(s):  
Masroor Ahmed ◽  
Badaruddin Sahito ◽  
Rukhsana Hamid ◽  
Nida ◽  
Mukesh Kumar ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Humeral Fracture ◽  
Functional Results ◽  
Treatment Method ◽  
Clinical Results ◽  
Percutaneous Pinning ◽  
Supracondylar Humeral Fracture ◽  
Type Iii ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures

Objectives: The objective of this study is to assess the functional outcome of close reduction and percutaneous K- wire fixation in supracondylar humeral fracture (SCHF) Gartland type III fractures in children. Study Design: Experimental study. Period: January 2017 to December 2017. Setting: Department of Orthopedics Civil Hospital Karachi. Material & methods: 60 children sustaining a Gartland type III supracondylar humerus fractures less than 1 week old that was treated by closed reduction and percutaneous pinning. Clinical results were evaluated using the Flynn’s criteria. Results: All the 60 children with Gartland type III supracondylar humerus fracture included in this study. 42 (70%) boys and 18 (30%) girls with age ranging between 2 to 10 years .Right side was involved in 37(62%) and left side was involved in 23 (38%) patients. All patients are of extension type fracture. According to Flynn’s criteria cosmetic results were excellent in 54 (90%) and good in 6 (10%) patients and functional results were excellent in 54 (90%), good in 4(7%), fair in 2 (2%) and poor in 1(1%) patient. One patient ulnar nerve injury, after 3 months nerve explored that was contused, symptoms resolved afterwards. Conclusion: Close reduction and percutaneous fixation with K-wire in Gartland III fracture in children is safe and effective treatment method with minimal hospital stay and less complications.

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

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

scholarly journals Inferior Patella Dislocation due to Impaction in the Femoral Trochlea

2021 ◽  
pp. 89-92
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory
Keyword(s):  
Closed Reduction ◽  
Early Mobilization ◽  
Patella Dislocation ◽  
Type Ii ◽  
Rare Presentation ◽  
Femoral Trochlea ◽  
Inferior Pole ◽  
Locked Knee ◽  
Inferior Dislocation ◽  
Superior Pole

Acute inferior dislocation of the patella is a rare presentation in trauma and orthopaedics. Type II is caused by direct upward force on the inferior pole of the patella when the knee is flexed impacting the superior pole osteophyte into the intercondylar notch. Impaction in the femoral trochlea is rarely reported. A 92-year-old lady presented with locked knee held in 85° of flexion with an abnormal knee contour. Radiographs demonstrated that the upper pole of the patella was impacted in the femoral trochlea with a fracture of a superior pole osteophyte. The extensor mechanism was intact. Closed reduction is achieved under strong opioid pain relief. The patient returned to her baseline knee function within 6 weeks. Closed reduction of an inferior patellar dislocation in elderly patients is aided by superior pole osteophyte fracture and facilitates early mobilization, and avoidance of general anaesthesia.

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