scholarly journals SUPRACONDYLAR HUMERUS FRACTURES

2011 ◽  
Vol 18 (01) ◽  
pp. 147-153
Author(s):  
NOOR AKBAR SIAL ◽  
ABID RASHID ◽  
AJMAL YASIN
Keyword(s):  
Open Reduction ◽  
Kirschner Wire ◽  
University Hospital ◽  
Supracondylar Fractures ◽  
Medical College ◽  
Pin Fixation ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Grade Ii

Displaced Supracondylar fractures of the humerus in children are common injuries treated by orthopaedic surgeons. Objectives: To evaluate the role of open reduction and percutaneous crossed pin fixation in displayed supracondylar fractures and to design a simple and effective protocol for the treatment of these fractures. Design: Prospective. Setting: Independent Medical College Independent University Hospital Faisalabad. Period: From January 2009 to June 2010. Method: Fifty six cases with grade II and grade III Gartland Supracondylar humeral fractures were treated with open reduction through postereomedial approach and percutaneous crossed pin fixation with Kirschner wire and followed up for a minimum period of 1 year. Results: Patients were assessed on the basis of Flynn’s criteria there were 41 Excellent and12 good results Conclusions: It is concluded that open reduction and percutaneous crossed pin fixation is a sound and effective treatment for displayed supracondylar fractures with several advantages but requires careful judgment on the part of surgeon to avoid complications.

scholarly journals “DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Gheorghe Burnei ◽  
Ionuţ Răducan ◽  
Florin-Daniel Enache ◽  
Adriana Dărăban ◽  
Cecilia Avram ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
San Antonio ◽  
Plaster Cast ◽  
Experimental Program ◽  
Supracondylar Fractures ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Elbow Pathology

Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery. Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals “Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

2021 ◽  
Author(s):  
Gheorghe Burnei ◽  
Ionut Daniel Răducan ◽  
Florin-Daniel Enache ◽  
Adriana Maria Dărăban ◽  
Cecilia Roberta Avram ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
San Antonio ◽  
Plaster Cast ◽  
Experimental Program ◽  
Medial Approach ◽  
Supracondylar Humerus Fractures ◽  
Supracondylar Humeral Fractures ◽  
Background Context

Abstract Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented. Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001–2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982–2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification. All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program. Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms. Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.</p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.</p>

scholarly journals Outcomes of Pediatric Supracondylar Fractures of Humerus Treated by Posterior Triceps Splitting Approach

2016 ◽  
Vol 4 (1) ◽  
pp. 28
Author(s):  
Rajeev Dwivedi ◽  
Ruban Raj Joshi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Standard Treatment ◽  
Functional Results ◽  
Supracondylar Fracture ◽  
Supracondylar Fractures ◽  
Radiological Criteria ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Mean Time

Introduction: Close reductions and percutaneous pinning is the gold standard treatment for supracondylar fracture  of humerus. Open reduction and internal fixation is indicated in patients with unacceptable closed reduction, neurovascular compromise, and open fractures. Open reduction can be performed through various approaches. Every approach has their advantages and limitations. The aim of this study was  to assess the functional outcome of pediatric supracondylar fracture of humerus treated by posterior triceps splitting approach.   Methods: This was a prospective evaluation of 20 consecutive patients with displaced pediatric supracondylar humeral fractures operated by triceps spitting posterior approach in our institution for two years. At initial presentation, 19 cases were Gartland III  and one was flexion variant of injury. Complications such as reduction loss, pin migration, infection, osteonecrosis of any part of the elbow, bone healing, and functional results were evaluated. Flynn criteria were used to evaluate the final results.   Results: Twenty patients underwent open reduction and internal fixation by triceps splitting approach. Thirteen patients were male and seven were female with M:F ratio of 1.86:1. The mean age was 6.8 yr (SD=2.74, range 2-14). All the fractures united by six weeks; mean time for union was 4.5 wk (SD=0.94). All patients were assessed at six months using Flynn clinical and radiological criteria. Results were satisfactory in all patients.   Conclusion: Posterior triceps splitting approach is simple, safe and has good functional and radiological outcome. We recommend this approach  for open reduction and internal fixation in pediatric supracondylar fracture.

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

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.

scholarly journals Paediatric supracondylar humeral fractures: the effect of the surgical specialty on the outcomes

2019 ◽  
Vol 13 (1) ◽  
pp. 40-46 ◽  
Author(s):  
A. J. Saarinen ◽  
I. Helenius
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Supracondylar Fractures ◽  
Level Of Evidence ◽  
Surgical Specialty ◽  
Orthopaedic Surgeons ◽  
Loss Of Reduction ◽  
Supracondylar Humeral Fractures ◽  
Pin Configuration

PurposeThe effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.MethodsA retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.ResultsResidents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).ConclusionWe found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.Level of evidence:Level III

scholarly journals Perception About the Role of Anesthesia and Anesthesiologist Among the Paramedical Staffs: Perspective from a Medical College in Nepal

2013 ◽  
Vol 10 (2) ◽  
pp. 51-54 ◽  
Author(s):  
B Bhattarai ◽  
S Kandel ◽  
N Adhikari
Keyword(s):  
Intensive Care Unit ◽  
Chronic Pain ◽  
Medical Journal ◽  
Medical Science ◽  
University Hospital ◽  
Chronic Pain Management ◽  
Operation Theatre ◽  
Medical College ◽  
Post Operative Period

Background Anesthesiologists and anesthesia has been considered behind the scene. The image and status of anesthesiologist in the eyes of the medical and lay communities has always been a problem. Objectives This study was designed to assess the knowledge about the role of anesthesiologist among the paramedical staffs at Kathmandu University Hospital. Methods This prospective questionnaire based study was done at Kathmandu University School of Medical Science, Dhulikhel Hospital for 2nd January 2011 to 30th Jan 2011 among the paramedical staffs working in different department of the hospital. Results There were 150 questionnaire distributed out of which 120 responded. Mean Age was 23.33 and most of the respondents were female with majority having education qualification equivalent to intermediate level. Only 49.20 said it to be a different specialty and 72.5% said anaesthesiologist work differently in the theatre where as 70% knew anaesthesiologist did something in the post-operative period too. Conclusion Anesthesiologists have duty to visit patient’s pre operatively and post operatively. The role inside the theatre and expanding role outside the theatre is poorly known. The awareness about the role of anesthesiologist in operation theatre, in intensive care unit, acute and chronic pain management and emergency care areas should be highlighted to all the staffs. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 51-54 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7344

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