scholarly journals SUPRA CONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN;

2013 ◽  
Vol 20 (03) ◽  
pp. 456-461
Author(s):  
MOGHEES IKRAM AMEEN ◽  
AQEEL SAFDAR ◽  
FAUZIA MOGHEES
Keyword(s):  
Nerve Palsy ◽  
Neurological Complications ◽  
Late Presentation ◽  
Radial Nerve Palsy ◽  
X Rays ◽  
Supracondylar Fractures ◽  
Post Injury ◽  
Type Iii ◽  
Fractures In Children ◽  
Median Nerve Palsy

Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients presentvery late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years withsupra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried outand necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation bytraditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% wereType I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositisossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displacedsupracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by OpenReduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocolhad to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full rangeof movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction andlifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus inchildren different management protocols have to be made, tailored to individual needs of the patient.

scholarly journals Closed pinning for paediatric supracondylar fractures: does timing really matter?

2017 ◽  
Vol 3 (3) ◽  
pp. 417
Author(s):  
Suresh Babu Surapaneni ◽  
Ravi Kiran Kopuri ◽  
Venkata Suresh Babu Tummala
Keyword(s):  
Closed Reduction ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Radial Pulse ◽  
Supracondylar Fractures ◽  
Average Delay ◽  
Median Nerve Palsy ◽  
Ulnar Nerve Palsy ◽  
Pin Fixation ◽  
Group 2

<p><strong>Background:</strong> Management guidelines and comparative studies are not yet clear for those patients who present early and late with widely displaced supracondyle humerus fracture in children.</p><p><strong>Methods:</strong> A total of 74 children were included in this study, 30 patients presenting early within 24 hours as group 1, and 44 patients who presented late i.e. after 24 hours and within a week as group 2 underwent closed reduction and pinning.<strong></strong></p><p><strong>Results: </strong>In group one 24 had excellent, 6 had good results, according to modified Flynn’s criteria. One patient developed ulnar nerve palsy which was iatrogenic, and improved completely after wire removal. Another was brachial artery injury which was explored and recovered completely. In group 2 the average delay in presentation was 57.56 hours; mean time to surgery after presentation was 9.83 hours. Sixteen patients (36.36%) had neurologic complications at presentation to the emergency room of which three had median nerve palsy (6.81%) whereas seven (15.90%) had isolated anterior interosseous nerve palsy and six (13.6%) had radial nerve palsy all patients showed total neurological recovery at 12 weeks. Six patients (13.63%) had vascular compromise at initial presentation of which five patients had feeble radial pulse and one had absent radial pulse, but capillary filling was adequate in all. The pulse was restored within 24 hours in all patients following reduction. There were 37 excellent, 6 good and 1fair results.</p><p><strong>Conclusions:</strong> Our results support, closed reduction and Percutaneous pin fixation as an effective treatment option for grossly displaced supracondylar fractures presenting early and late but requires good and careful judgment and also technique.</p>

scholarly journals Operative management of type III extension supracondylar fractures in children

2008 ◽  
Vol 33 (4) ◽  
pp. 1089-1094 ◽  
Author(s):  
Cemal Kazimoglu ◽  
Murat Çetin ◽  
Muhittin Şener ◽  
Haluk Aguş ◽  
Önder Kalanderer
Keyword(s):  
Operative Management ◽  
Supracondylar Fractures ◽  
Type Iii ◽  
Fractures In Children

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 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 OPEN REDUCTION AND K-WIRE FIXATION OF DISPLACED UNSTABLE LATERAL CONDYLE FRACTURES OF THE HUMERUS IN CHILDREN

2011 ◽  
Vol 18 (03) ◽  
pp. 501-509
Author(s):  
NOOR AKBAR SIAL ◽  
MUHAMMAD JAVAID IQBAL ◽  
MUHAMMAD KALEEM SHAUKAT
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Late Presentation ◽  
Lateral Condyle ◽  
Post Injury ◽  
Medical College ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Wire Fixation ◽  
K Wires

Background: Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. Objective: To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Design: Prospective. Setting: Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. Period: From January 2008 to December 2010. Method: In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Results: Excellent to good results were observed in all the12 patients presenting at 1–4 weeks post injury. In 5 patients presenting at 5–8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Conclusions: Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate.

SPLINTING FOR PERIPHERAL NERVE INJURY IN UPPER LIMB

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 251-259 ◽  
Author(s):  
Rebecca K. Y. Chan
Keyword(s):  
Peripheral Nerve ◽  
Nerve Palsy ◽  
Injury Severity ◽  
Nerve Repair ◽  
Hand Function ◽  
Radial Nerve Palsy ◽  
Joint Contractures ◽  
Median Nerve Palsy ◽  
Ulnar Nerve Palsy ◽  
Severity Of Injury

The prognosis and speed of peripheral nerve recovery depend very much on the level of injury, severity of injury, the surgical intervention and the subsequent rehabilitative process. Many high level injuries may take years or months for the affected peripheral nerve to recover. Prolonged muscle imbalance causes joint contractures and over-stretching of denervated muscles. Without proper care, hand function recovery may be limited even the nerve regenerated afterwards. During the nerve regeneration period, splinting is one of the most useful modality to minimise deformities, prevent joint contractures and substitute loss motor control. Proper splinting encourages early use of the injured hand in daily activities. There are different types of splinting design for median nerve palsy, ulnar nerve palsy and radial nerve palsy. Dynamic splinting techniques are frequently employed to allow early prehension activities. Other therapeutic techniques, including pressure garment and sensory re-education are useful to enhance better functional return after nerve repair.

Neurological

2019 ◽  
pp. 109-186
Author(s):  
Tanya M. Monaghan ◽  
James D. Thomas
Keyword(s):  
Nerve Palsy ◽  
Cauda Equina ◽  
Radial Nerve Palsy ◽  
Pseudobulbar Palsy ◽  
Subacute Combined Degeneration ◽  
Charcot Marie Tooth Disease ◽  
Tabes Dorsalis ◽  
Median Nerve Palsy ◽  
Ulnar Nerve Palsy ◽  
Muscles Of The Hand

This chapter concerns neurological medicine, and covers dermatomes, peripheral nerves and tendon reflexes, peripheral neuropathy, hemiplegia, myotonic dystrophy, proximal myopathy, motor neurone disease, cerebellar syndrome, myasthenia gravis, cervical myelopathy, median nerve palsy, ulnar nerve palsy, radial nerve palsy, wasting of the small muscles of the hand, syringomyelia, polymyositis, Parkinson’s disease, Friedreich’s ataxia, Charcot–Marie–Tooth disease, subacute combined degeneration of the cord, tabes dorsalis, cerebellopontine angle syndrome, paraplegia, visual field defect, nerve palsy, nystagmus, Horner’s syndrome, ptosis, large pupil, small pupil, Holmes–Adie–Moore syndrome, Argyll Robertson pupil, internuclear ophthalmoplegia, facial palsy, bulbar palsy, pseudobulbar palsy, and cauda equina syndrome.

scholarly journals Open Reduction and Internal Fixation of Displaced Supracondylar Fracture of Late Presentation in Children: A Preliminary Report

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ram K. Shah ◽  
Raju Rijal ◽  
Rosan P. Shah Kalawar ◽  
Sujit R. Shrestha ◽  
Niraj Kumar Shah
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Late Presentation ◽  
Supracondylar Fracture ◽  
Control Group ◽  
Joint Motion ◽  
Supracondylar Fractures ◽  
Kirschner Wires ◽  
Multicentric Study ◽  
Fractures In Children

Background. In late presentation of cases there is dilemma whether to wait for osteotomy later or do open reduction on arrival. The purpose of this prospective multicentric study is to evaluate the functional outcome of open reduction and internal fixation (ORIF) with crossed Kirschner wires fixation and early joint motion in the late presentation of supracondylar fractures in children. Methods. A total of 21 children, with an average delay of 20.3 days, with displaced type III Gartland supracondylar fracture, were treated by ORIF with crossed Kirschner wires fixation and early joint motion. Average follow-up was 12 months. Results. Flynn’s criteria were used to evaluate the outcome. All of them had more functional range of motion of the injured elbow than the published reports. Conclusions. Most of the surgeons in the developing world prefer ORIF for optimal results. Thus it appears to be justifiable to go for ORIF with K-wires even in the late presentation of supracondylar fractures. The overall results are encouraging. However, the small number of cases and lack of control group are the limitations of this study. The study is ongoing and so the full report with more cases will be presented later.

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