Therapeutically effect of the physical procedures on the elbow contractures in children with supracondylar humerus fractures

Supracondylar humerus fractures are the most common fracture around the elbow in the pediatric population. These fractures in children may lead to functional disturbance with loss or reduction of range of motion in the elbow joint. The aim of this study was to investigate the effect of the physical therapy on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood after supracondylar fractures. We analyzed in this research 34 children (average age 8.57+2.94 years) with elbow contractures that were treated by physical therapy after orthopedic treatment. Functional outcome was presented in degree from 1 to 3 (Flynn). The difference in the grade at the beginning and the end of the therapy is statistically significant (t=16.38, p<0.001). 91.18 %, of the children had excellent result. Complex of various therapeutically physical procedures can significant improve range of motion of the elbow joint. .

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

10.53350/pjmhs2115103482 ◽

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

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Does the timing of surgery affect outcomes of gartland type III supracondylar fractures in children?

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7225-32 ◽

2019 ◽

Vol 7 (2) ◽

pp. 25-32

Author(s):

Hyun-Chul Shon ◽

Ji Wan Kim ◽

Hun-Kyu Shin ◽

Eugene Kim ◽

Se-Jin Park ◽

...

Keyword(s):

Range Of Motion ◽

Clinical Outcomes ◽

Operation Time ◽

Timing Of Surgery ◽

Bone Union ◽

Supracondylar Fractures ◽

Type Iii ◽

Fractures In Children ◽

Pin Fixation ◽

Supracondylar Humerus Fractures

Background. Gartland type III supracondylar fractures in children are treated as emergency. But there are few studies about surgical timing and clinical outcomes. Aim. To evaluate whether the time interval from injury to surgical treatment affects the treatment outcomes of Gartland type III supracondylar fractures in children. Methods. The study population comprised all children presenting to our hospital between April 2003 and December 2013, who had Gartland type III supracondylar humerus fracture. Patients were divided into three groups: those who were treated within less than six hours from injury, those who were treated between six and twelve hours, and those who were treated between twelve and twenty four hours after injury. In this retrospective study, we checked whether the timing of surgery affected clinical outcomes such as bone union, range of motion, peri-operative complications, and operation time. Results. All patients were treated with closed reduction and percutaneous pin fixation within 24 hours. This study showed a trend that the delay in the timing of surgery after traumatic injury increases operation time, however with no statistical differences. The neurological complications were similar in the three groups. There were 11 cases (14.7%) of preoperative neurologic deficit, however every patient recovered postoperatively. There was no difference between the three groups in terms of clinical outcomes such as range of motion of the elbow and bone union. Conclusion. For Gartland III pediatric supracondylar humerus fractures, operation can be delayed for up to 24 hours, which may allow time for operation during regular hours, rather than late at night, with thorough evaluation of circulation, nerve injury, and swelling.

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Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v1i2.16643 ◽

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.

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Supracondylar fractures of the humerus in children: is departmental documentation hitting national standards?

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0280 ◽

2021 ◽

pp. 1-8

Author(s):

Neil J Jones ◽

Oliver Clough ◽

Andrew Gaukroger ◽

Surendra Patnaik

Keyword(s):

National Standards ◽

Radial Pulse ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Anterior Interosseous Nerve ◽

The Status ◽

Humerus Fractures ◽

The Individual ◽

Pro Forma

Background/aims The British Orthopaedic Association's Standards for Trauma for the management of supracondylar humerus fractures in children specify that: ‘A documented assessment of the limb, performed on presentation, must include the status of radial pulse, digital capillary refill time and the individual function of the radial, median (including anterior interosseous) and ulnar nerves.’ Methods The documentation of cases of supracondylar humerus fractures over 1 year was retrospectively analysed. An electronic pro forma for supracondylar humerus fractures was introduced, with prompts for the pieces of documentation required to meet national standards. The use of this pro forma was audited after 6 months and 12 months use. Results Documentation ranged from 10% for anterior interosseous nerve to 53% for radial pulse. In the second reaudit, documentation ranged from 86% for anterior interosseous nerve to 95% for median nerve function. There were 17 patients for whom all documentation was present, and for these patients the pro forma had been used. Use of an electronic clerking pro forma improves adherence. Conclusions Full documentation of neurovascular status in paediatric supracondylar fractures is vital to allow for effective preoperative and postoperative further assessment. With the move into paperless documentation, online pro formas can help clinicians with effective assessment and documentation.

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Dislocated Extension – Type Supracondylar Humerus Fractures in Children: Single Centre Experience

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.005 ◽

2014 ◽

Vol 2 (1) ◽

pp. 29-33

Author(s):

Lazar Todorovic ◽

Mile Petrovski ◽

Aco Dimov ◽

Riste Simeonov ◽

Marjan Kamiloski ◽

...

Keyword(s):

Supracondylar Fractures ◽

Cubitus Valgus ◽

Fractures In Children ◽

Number Of Patients ◽

Single Centre Experience ◽

Supracondylar Humerus Fractures ◽

Supracondylar Humeral Fractures ◽

Humerus Fractures

Aim: The aim of this study is to show our experience in cases of dislocated extension type – supracondylar humeral fractures and evaluate the results of their treatment in the period from 2000 to 2010 with a follow up of a maximum six months.Material and Methods: A retrospective analysis of the clinical cases for the period 2000 – 2010 was done. Children from 4 to 14 years of age with supracondylar fractures of the humerus – extension type are included. The total number of patients treated at the Clinic for Pediatric Surgery was 230.Results: The results of the treatment were evaluated after the last control examination six months later. We noticed postoperative neurological damage in 10 cases (4.85%). In 14 patients (6.8%) we noticed long term deformities such as cubitus varus or cubitus valgus. Infection at the entering place of the needles occurred in 4 patients (1.94%), which did not indicate premature extraction of the needles and conversion of the treatment.Conclusion: As a conclusion, we can stress that our outcomes in treatment of dislocated suparacondylar fractures of the humerus in children meet the world standards.

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The role of physical therapy in the treatment of post-traumatic contracture of the elbow in children

Medicinski pregled ◽

10.2298/mpns1702058b ◽

2017 ◽

Vol 70 (1-2) ◽

pp. 58-61

Author(s):

Maja Bogdan ◽

Aleksandra Mikov

Keyword(s):

Physical Therapy ◽

Range Of Motion ◽

Elbow Joint ◽

Neurological Deficits ◽

Contributing Factors ◽

Fractures In Children ◽

Elbow Fractures ◽

Elbow Injuries ◽

Post Traumatic ◽

Occupational And Physical Therapy

Introduction. Elbow fractures account for 7-9% of all fractures in children, while supracondylar humeral fractures are the most common fractures in the elbow joint region. Most of these fractures are seen in children between 5 and 8 years of age. Management of elbow injuries. Orthopedic treatment of elbow injuries includes conservative and/or surgical treatment, and outcomes are much better in children than in adults. The main contributing factors to the development of elbow contractures include the severity of the trauma, intra-articular damage, and length of immobilization. The literature is still limited in terms of the time required for regaining good elbow range of motion after contracture. Complication of elbow injuries. Neurological deficits may be treated conservatively, by electrical stimulation, vitamin therapy and intensive exercises. Physical therapy of elbow contracture. Some authors showed that, in uncomplicated cases of supracondylar elbow fractures, physical therapy is not necessary in order to regain adequate range of motion. On the other hand, according to guide recommendations, after post-traumatic elbow immobilisation and reduced mobility, patients should undergo occupational and physical therapy as soon as possible after the period of immobilization. It has been proven that combined active and passive therapeutic programs significantly improve the range of motion of the elbow joint. Conclusion. The therapeutic approach to post-traumatic contracture of the elbow should be individual, patiently and properly dosed, with follow-up of pathogenesis and kinesiology disorders. However, physicians should be aware of the fact that particular attention should primarily be paid to the prevention of contractures. This article has been corrected. Link to the correction <a href="http://dx.doi.org/10.2298/MPNS1708202E">10.2298/MPNS1708202E</a>

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