scholarly journals Open reduction and percutaneous pinning via lateral approach without using C-arm in Gartland type III supracondylar humerus fractures in children

2019 ◽  
Vol 7 (11) ◽  
Author(s):  
Tanveer Ahmed Bhat ◽  
Keyword(s):  
Open Reduction ◽  
Lateral Approach ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

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 Treatment of Pediatric Lateral Condylar Humerus Fractures with Closed Reduction and Percutaneous Pinning

2020 ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Fractures In Children ◽  
Humerus Fractures

Abstract Background: Lateral condylar humerus fractures (LCHFs) are the second most common fractures in children. Open reduction and internal fixation is recommended for fractures displaced by more than 4 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction and fixation are necessary to ensure a fracture gap less than 2.0 mm both on anteroposterior view and oblique internal rotational view by fluoroscopy. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

Comparison of Outcome of Three Different Approaches for Supracondylar Humerus Fractures in Children

2021 ◽  
Vol 15 (10) ◽  
pp. 3482-3484
Author(s):  
Syed Usman Shah ◽  
Mohammad Younas ◽  
Naseer Ullah Khattak ◽  
Amina Gul Shehzar Khan ◽  
Sultan Shah ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Lateral Approach ◽  
Supracondylar Fractures ◽  
Medial Approach ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Group A ◽  
Humerus Fractures ◽  
Group B

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

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 Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng ◽  
Ren-huan Zhao ◽  
Wei Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Articular Surface ◽  
Stage Iv ◽  
Distal Humerus ◽  
Percutaneous Pinning ◽  
Type Iii ◽  
Humerus Fractures

Abstract Background Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon. Results Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.

scholarly journals Analysis of clinicoradiological parameters following fixation of paediatric supracondylar humerus fractures with three lateral pins

2019 ◽  
Vol 5 (2) ◽  
pp. 310
Author(s):  
Saurabh Daga ◽  
Pushpal Sarkar ◽  
Paras Kumar Banka
Keyword(s):  
Percutaneous Pinning ◽  
Kirschner Wires ◽  
Medical College ◽  
Normal Limits ◽  
Fractures In Children ◽  
Ulnar Nerve Palsy ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures ◽  
A Prospective Study ◽  
Pin Configuration

<p class="abstract"><strong>Background:</strong> Supracondylar humerus fractures are one of the commonest fractures encountered in children. This fracture has been managed both conservatively with a long arm plaster and operatively by fixing with Kirschner wires. Debate still remains regarding the pin configuration to be used for fracture stabilisation. This study analyses the clinical and radiological parameters following fixation of supracondylar humerus fractures in paediatric patients with three lateral pins.</p><p class="abstract"><strong>Methods:</strong> It is a prospective study with 30 patients conducted between April 2016 and September 2016 conducted in Medical College and Hospital, Kolkata. All the said patients underwent closed reduction and percutaneous pinning with three laterally placed divergent kirschner wires.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the patients in this study had clinicoradiological parameters well within normal limits, barring a few. The baumann’s angle was well within normal limits in these cases as found in subsequent follow-ups.</p><p class="abstract"><strong>Conclusions:</strong> In this study, it was found that lateral pinning can be safely employed for fixing supracondylar humerus fractures in children with lesser chances of iatrogenic ulnar nerve palsy which was encountered with crossed pin configuration.</p><p> </p>

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