Radiation Exposure in The Treatment of Pediatric Supracondylar Humerus Fractures: Comparison of Two Fixation Methods

Background: Supracondylar fractures of the humerus are the most common fracture pattern of the elbow in children. Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. The purpose of this study was to evaluate the results of stabilization of these fractures by closed reduction and percutaneous Kirschner wire fixation.Methods: Thirty cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patient was 8.3 years [ranges from 4-14 years]. The male to female ratio was 2:1 and left side was involved in 23 cases whereas 7 had right sided injuries. All fractures were of extension type [Gartland’s type III]. Posteromedial displacement was noted in 22 cases whereas 8 fractures were posterolaterally displaced. In 20 cases, lateral entry wires alone were used whereas in 10 cases one lateral and one medial K-wire were used. K- wires were removed after 3 weeks post-operatively and follow-up was done at 6 weeks,12 weeks, 6 months and 12 months, when they were evaluated according to Flynn’s criteria.Results: Results were graded using Flynn’s criteria. Excellent results were achieved in 18 [60%], good in 6 [20%] fair in 4 [13.3%], while poor results were seen in 2 [6.7%] patients.Conclusions: Closed reduction and percutaneous fixation using Kirschner wires is a safe and efficient method for fixation of displaced supracondylar fractures of the humerus in children.

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Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170080 ◽

2017 ◽

Vol 3 (2) ◽

pp. 271

Author(s):

Nilesh Janardan Keche ◽

Abhijit Bhimrao Kale ◽

Binoti Arun Sheth ◽

Ashok Kumar Rathod

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Fixation Method ◽

Elbow Fracture ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Group 2 ◽

K Wires ◽

Group 1

Background: Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches.Methods: In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.Results: The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3rd and 9th month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2. Conclusions: Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results.

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DISPLACED SUPRACONDYLAR HUMERAL FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1507 ◽

2013 ◽

Vol 20 (05) ◽

pp. 818-824

Author(s):

ZAKIR ALI SHAH, ◽

UZMA ARIF

Keyword(s):

Range Of Motion ◽

Controlled Trial ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Loss Of Reduction ◽

Wire Fixation ◽

Supracondylar Humeral Fractures ◽

Group A ◽

K Wires ◽

Group B

Objective: To compare outcome of patients with supracondylar fractures of humerus treated by cross k wires and lateralentry k wires in children. Study Design: Randomized controlled trial study. Place and duration of study: January 2012 to December2012 at Department of Orthopedics, Nawaz Sharif Social Security hospital, Lahore. Subjects and Methods: Two hundred patients,meeting the selection criteria were identified. These patients were divided into group A and group B randomly. In group A cross k wirefixation and in group B lateral entry k wire fixation was performed. Loss of reduction was assessed and recorded in the immediatepostoperative period and three weeks later at the time of removal of k wires. Range of motion of the elbow, in the form of excellent outcomewas assessed at the end of 12 weeks postoperatively. Results: A total of 200 patients were included in the study. Loss of reduction wasfound in thirty patients (30%) in group A and in forty one patients (41%) in group B. In group A, seventy two patients (72%) had excellentoutcome while twenty eight patients (28%) did not gain the desired range of motion at elbow. In group B, sixty five patients (65%) hadexcellent outcome while in thirty five patients (35%), the desired range of motion at elbow was not achieved. No neurological injuryoccurred with both configurations. Conclusions: Lateral entry k wire fixation is as effective as cross k wire in the treatment of displacedsupracondyler fracture of humerus in children.

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Paediatric orthopaedics in lockdown

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0086.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 424-430

Author(s):

Ian Baxter ◽

Graeme Hancock ◽

Matthew Clark ◽

Matthew Hampton ◽

Adelle Fishlock ◽

...

Keyword(s):

Trauma Centre ◽

Supracondylar Fractures ◽

Cast Immobilization ◽

Fracture Clinic ◽

Clinic Management ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Limb Injuries ◽

Proportional Increase ◽

The Impact

Aims To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430.

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Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22034 ◽

2019 ◽

Vol 10 (2) ◽

pp. 58-61

Author(s):

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pabin Thapa ◽

Upendra Jung Thapa ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Distal Humerus ◽

Supracondylar Fracture ◽

Good Stability ◽

Lateral Side ◽

Supracondylar Fractures ◽

Wire Fixation ◽

Ulnar Nerve Injury ◽

K Wires

Background: Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability. Materials and Methods: This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture. Result: Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups. Conclusion: Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

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Paediatric orthopaedics in lockdown

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0086.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 424-430

Author(s):

Ian Baxter ◽

Graeme Hancock ◽

Matthew Clark ◽

Matthew Hampton ◽

Adelle Fishlock ◽

...

Keyword(s):

Trauma Centre ◽

Supracondylar Fractures ◽

Cast Immobilization ◽

Fracture Clinic ◽

Clinic Management ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Limb Injuries ◽

Proportional Increase ◽

The Impact

Aims To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430.

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Biomechanical Analysis of Sagittal Plane Pin Placement Configurations for Pediatric Supracondylar Humerus Fractures

Applied Sciences ◽

10.3390/app11083447 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3447

Author(s):

Witit Pothong ◽

Phichayut Phinyo ◽

Yuddhasert Sirirungruangsarn ◽

Kriengkrai Nabudda ◽

Nattamon Wongba ◽

...

Keyword(s):

Sagittal Plane ◽

External Rotation ◽

Fracture Site ◽

Biomechanical Analysis ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Supracondylar Humerus Fractures ◽

Loading Patterns ◽

Loading Tests ◽

Pin Configuration

Anterior to posterior (AP) pinning is the recommended sagittal pin configuration in divergent lateral entry coronal pinning of pediatrics supracondylar fractures. However, there was still a lack of evidence regarding alternative sagittal pins configurations. We aimed to compare the construct stiffness of alternative sagittal pin configurations by using synthetic bone models. Sixty synthetic pediatric humeri were osteotomized to create a supracondylar fracture. After the fracture reduction, all specimens were fixed in the coronal plane with divergent lateral entry pin configurations in four different patterns in the sagittal plane: AP, crossed, divergent and parallel sagittal pin configuration. Each configuration was tested with five loading patterns. The AP sagittal pin had significantly lower construct stiffness than the divergent (p = 0.003) and the parallel sagittal pin configuration (p = 0.005) in external rotation loading tests. The divergent sagittal pin had the highest construct stiffness in extension, valgus, and external rotation loads, but the parallel sagittal pin had lower construct stiffness under extension load than the divergent and crossed sagittal pin configurations. The divergent sagittal pin configuration provides greater construct stiffness than other sagittal pin configurations due to the maximal pin spreading distance at the fracture site and the pin angle lock mechanism.

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Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning

Journal of Nepal Medical Association ◽

10.31729/jnma.314 ◽

2008 ◽

Vol 47 (170) ◽

Cited By ~ 8

Author(s):

Pramod Devkota ◽

JA Khan ◽

BM Acharya ◽

NMS Pradhan ◽

LP Mainali ◽

...

Keyword(s):

Tract Infection ◽

Closed Reduction ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Treatment Results ◽

Wire Fixation ◽

Ulnar Nerve Injury ◽

K Wires ◽

Pin Tract Infection

Supracondylar fractures of humerus in children are common injuries. Displaced fractures areinherently unstable. Conservative treatment results in malunion. Open reduction and internalfixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102displacedsupracondylarfractures of humerus, agedbetween one andhalf yearto 13 years, weretreated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wireswereput.Above elbow plaster ofparis back slab was appliedinall cases for atleastfour weeks.Backslab,K-wireswere removedafterfourweeks andelbowrangeofmotionexercisewas started.Resultswere analyzed using Flynn’s criteria. All patients were followed up to 14th week postoperatively. Incross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively.We recommend this procedure fordisplacedsupracondylarfractures inchildrenas itis safeandcost effectiveprocedurewithacceptablecomplication rates.Key words: closed reduction, humerus, percutaneous pinning, supracondylar fracture

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A study on management of paediatric supracondylar humerus fractures with lateral percutaneous Kirschner wire fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193834 ◽

2019 ◽

Vol 5 (5) ◽

pp. 911

Author(s):

Wazir Fahad Jan ◽

Umer Mushtaq Khan ◽

Haamid Rafiq Bhat ◽

Sumaya Zeerak

Keyword(s):

Kirschner Wire ◽

Functional Results ◽

Supracondylar Fractures ◽

College Hospital ◽

Medical College ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Cosmetic Outcomes ◽

Humerus Fractures

Background: Supracondylar fracture of the humerus in children is a common injury encountered in orthopaedic practice. Undisplaced fractures can be managed conservatively, however displaced fractures need proper reduction and adequate fixation for attainment of optimal functional and cosmetic outcomes. The purpose of this study was to evaluate the effectiveness of lateral percutaneous Kirschner (K) wire fixation in the management of displaced supracondylar fractures in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 70 patients of either sex with an average age of 5.98 years, presenting to the Orthopaedic Department of S.H.K.M. Government Medical College Hospital, Nalhar, Nuh, Haryana between February 2016 and February 2018, with displaced supracondylar fractures of humerus. All the patients were managed by closed reduction and percutaneous lateral K wire fixation. The patients were followed up for a period of 1 year. The patients were analyzed for union and functional results.Results: All the fractures united with an average time of union of 3.8 weeks. Functional results were assessed using Flynn’s criteria, which were excellent in 58 (82.86%), good in 7 (10%), fair in 3 (4.28%) and poor in 2 (2.86%) patients.Conclusions: Thus results of our study demonstrate that the lateral percutaneous K wire fixation is a safe and effective method of treatment of displaced paediatric supracondylar humerus fractures.

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Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

ISRN Orthopedics ◽

10.5402/2011/137372 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Stephen Paul Guy ◽

Ramakrishna Rao Ponnuru ◽

Sreenadh Gella ◽

Nirmal Tulwa

Keyword(s):

Primary Study ◽

Lateral Side ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Lateral Entry ◽

Elbow Injury ◽

Median Nerve Palsy ◽

Carrying Angle ◽

K Wires ◽

Displaced Fracture

Background. Supracondylar fractures are the commonest elbow injury in children. Most displaced supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. This clinical study has results purely from a three lateral divergent wire technique. Methods. Displaced supracondylar fractures were manipulated closed and three lateral divergent wires inserted. Primary study end points were range of movement and carrying angle relative to the contralateral uninjured elbow (Flynn's grading system) and presence of iatrogenic nerve or vessel injury. Results. 25 children between 3 and 10 years (median 5, range 3–10) suffered a displaced fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21 in the first 24 hours. 2 were delayed due to swelling. 2 were fixed secondarily with lateral k-wires after loss of position (from a primarily fixed crossed wire technique). One radial and one median nerve palsy sustained at injury settled. No iatrogenic nerve injuries occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading. Conclusions. The use of three wires on the lateral side in this cohort showed no evidence of slip in fracture position and no iatrogenic nerve injury.

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