Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children

Supracondylar humeral fractures are the most common injury of the elbow in children. Compared to flexion type fractures, extension type fractures are more common, up to 98%. Gartland classification has been used to guide the management of this injury, which is based on the extent of the displacement. If not adequately managed, completely displaced (type III) fractures may have a higher incidence of concomitant injury or complications, including neurovascular injury, compartment syndrome, or cubitus varus. Closed reduction followed by percutaneous pinning has been suggested as the standard operative method for the displaced supracondylar humeral fractures. However, these fractures can be challenging to reduce, with the traditional technique of closed reduction. Lateral-entry pinning is known as a sufficient method of fixation for this injury. However, the lateral pin only fixation technique may also result in loss of reduction in some particular patterns of fractures, such as fractures with medial column comminution. We discuss and describe the reduction techniques of completely displaced supracondylar humeral fractures, including technical tips and pitfalls for closed reduction and open reduction. We also discuss indications of medial pinning, and its safe method, when the lateral-entry pins may not achieve adequate stability.

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Neurological and Vascular Complications Associated with Supracondylar Humeral Fractures in Children

JBJS Reviews ◽

10.2106/jbjs.rvw.n.00084 ◽

2015 ◽

Vol 3 (12) ◽

Cited By ~ 2

Author(s):

Brian P. Scannell ◽

Brian K. Brighton ◽

Kelly L. VanderHave

Keyword(s):

Vascular Complications ◽

Humeral Fractures ◽

Fractures In Children ◽

Supracondylar Humeral Fractures

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Functional outcome of crossed Kirschner wire fixation in pediatric supracondylar humerus fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193823 ◽

2019 ◽

Vol 5 (5) ◽

pp. 772

Author(s):

Rahat Zahoor Moton ◽

Adeel Ahmed Siddiqui ◽

Muhammad Naseem ◽

Uzair Yaqoob ◽

Syed Amir Jalil ◽

...

Keyword(s):

Functional Outcome ◽

Kirschner Wire ◽

Humeral Fractures ◽

Treatment Modalities ◽

Class Iii ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Supracondylar Humeral Fractures

Background: Distal humeral fractures are one of the most common types of fractures in children, most of them being supracondylar. Supracondylar fractures are usually caused by trauma, most likely falls. It is an emergency, requiring rapid diagnosis and management to avoid serious complications. Recommended treatment modalities vary from no reduction and immobilization to open reduction and internal fixation. Kirschner wire (K-wire) fixation of displaced supracondylar fractures after closed reduction is a preferred method and is being performed for over 50 years now. This study was conducted to determine the functional outcome of crossed K-wire fixation in pediatric supracondylar fracture.Methods: This prospective study was conducted from May-November 2018 at the department of Orthopedics, Abbasi Shaheed Hospital, Karachi, Pakistan. It was inferred that functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation. It included 83 children with supracondylar fractures. They were treated with percutaneous crossed K-wire fixation. Patients were then followed up to determine satisfactory functional outcome according to Flynn’s criteria. Data entry and analysis was done using SPSS 21.0.Results: Eight-three patients were included. The mean±standard deviation age of this study population was 7.03±3.39 years. Out of the study participants, 47 (56.6%) were males and 36 (43.4%) were females. 71.1% of the patients were of Gartland class II fractures and 28.9% were of Gartland class III. 43.4% had an injury due to fall while playing while 19.3% had fallen from height. 80.7% were found to have a satisfactory functional outcome.Conclusions: It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.

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