Medio-lateral entry pin versus lateral entry pin for displaced pediatric supracondylar fractures: A comparative, prospective study

Background & Objectives: Supracondylar fracture is one of the commonest fractures in children. Although the technique of pinning is controversial, percutaneous medio-lateral entry pinning is theoretically considered more stable biomechanical construct. The drawback of this method is injury to ulnar nerve which is not encountered in only lateral entry pinning.Materials & Methods: This was a prospective, comparative and observational study done in 60 patients which was alternately divided into two groups. The first group (A) underwent medio-lateral entry pinning and the second group (B) underwent lateral entry pinning. They were followed for 24 weeks and the outcome was assessed using Flynn’s criteria.Results: At twenty-four weeks, the mean loss of range of motion of elbow in medio-lateral pinning group was 3.70 degrees (SD±1.93) and that in lateral pinning group was 4.23 degrees (SD ±1.38). The mean loss in carrying angle at twenty-four weeks in medio-lateral group was 2.93 degrees (SD±2.19) and that in lateral group was 4.17 (SD±2.24). There were 2 (6.67%) cases of iatrogenic ulnar nerve injury in medio-lateral pinning group. Out of thirty patients, in medio-lateral pinning group, 25 had excellent results, 5 had good results and none had fair or poor results. While out of 30 patients in lateral pinning group, 23 had excellent results, 7 had good results and none had fair or poor results.Conclusion: There is no significant difference in outcome in terms of loss of carrying angle and range of motion between the medio-lateral pinning group and the lateral pinning group at the end of 6 months.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 28-31

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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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SUPRACONDYLAR FRACTURE OF HUMERUS;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.03.2118 ◽

2012 ◽

Vol 19 (03) ◽

pp. 308-311

Author(s):

WASIM ANWAR ◽

Mohammad SIRAJ ◽

NOOR RAHMAN ◽

Malik Javed Iqbal ◽

Israr Ahmad ◽

...

Keyword(s):

Closed Reduction ◽

Supracondylar Fracture ◽

Cubitus Varus ◽

Supracondylar Fractures ◽

Injured Side ◽

Fractures In Children ◽

The Mean ◽

Carrying Angle ◽

One Year

Objectives: To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction andpercutaneous pinning. Material and Methods: This prospective study of 50 patients who presented with displaced supracondylar fracture ofhumerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar overperiod from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperativereduction was assessed by Baumann angle. All patients were followed for one year. Results: Mean age of the patients was 7.02 years± 2.25 SD. Loss of Baumann angle in injured side was range from 2O to 8O. Loss of carrying angle in injured side was range from 3O to 9O. WhenBaumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 ± 2.22 SDand 4.320 ± 1.52 SD respectively. Using Flynn’s criteria 36 (72%) patients out of 50 patients with carrying-angle loss considered to be excellentresults and 14(28%) good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Conclusions: Baumannangle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylarhumeral fractures in children.

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Functional and radiological outcome after closed reduction and percutaneous pinning versus open reduction and internal fixation in displaced supracondylar fractures in children

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v19i2.24545 ◽

2016 ◽

Vol 19 (2) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Amin Kumar Shrestha ◽

Suresh Uprety ◽

Govinda K.C. ◽

Sharma Paudel

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Supracondylar Fracture ◽

Age Group ◽

Radiological Outcome ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Significant Difference ◽

The Mean

Introduction: Supracondylar fracture of humerus is very common fracture in pediatric age group. The current trends of management in displaced type are close reduction and per cutaneous pinning (CRPP), if reduction is not satisfactory then open reduction and internal fixation (ORIF) is done. Our study aims to compare the cosmetic, functional and radiological outcome between these two methods. Methodology: Children with displaced extension type supracondylar fracture of distal humerus presenting to emergency room and orthopedics OPD who could meet the inclusion criteria were taken up for study. Sixty-three such patients (37 CRPP and 26 ORIF) were included in the study. Radiological and functional outcomes were followed up at 8 weeks post-operatively. Results: Of the 63 patients enrolled, 26 (41.3%) patients had undergone open reduction and internal fixation and 37 (58/7%) had undergone close reduction and percutaneous pinning. The mean age of patients in CRPP and ORIF groups was 7.29±2.3 years and 8.11±2.02 years respectively. Maximum patients were from age group 7-9 years (46%). Left side was more commonly injured (66.7% vs. 33.3%) (P = 0.045). According to the Flynn’s criteria, cosmetically the outcome did not differ between the two surgical groups (P = 0.23). However, CRPP proved to have a significantly better functional outcome (P=0.000). The mean Bauman’s angle in CRPP and ORIF groups was 16.89±5.66 and 18.88±4.90 degrees respectively. However, there is no statistically significant difference between the type of fixation and Bauman’s angle or Anterior humeral line. Conclusions: Close reduction and percutaneous pinning (CRPP) has better functional and radiological outcome in comparison with open reduction and internal fixation (ORIF) in displaced supracondylar fracture of humerus in children.

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Cross pinning versus lateral pinning in type III supracondylar fracture: a retrospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162619 ◽

2016 ◽

Vol 2 (3) ◽

pp. 138

Author(s):

Rajesh Govindasamy ◽

Ramkumar Gnanasundaram ◽

Saravanan Kasirajan ◽

Fawas Thonikadavath ◽

Rajeev K. Tiwari

Keyword(s):

Functional Outcome ◽

Retrospective Analysis ◽

Nerve Injury ◽

Ulnar Nerve ◽

Supracondylar Fractures ◽

Type Iii ◽

Loss Of Reduction ◽

Significant Difference ◽

Carrying Angle ◽

Ulnar Nerve Injury

Background: The commonly accepted treatment of type III supracondylar fractures of humerus in children is closed reduction percutaneous pinning (CRPP). There is a long debate over stability and complications associated with cross and lateral pinning. The present study compares the functional outcome and complications of both pinning techniques.Methods: A retrospective analysis of results with regard to ulnar nerve injury, carrying angle and range of movements was made in 27 children with lateral pinning and 28 children with crossed pinning was done in our institution. Functional outcome was graded according to Flynn’s criteria and loss of reduction by Skagg’s criteria.Results: There was no statistically significant difference with regard to functional outcome and loss of reduction between the two groups. Iatrogenic ulnar nerve injury (IUNI) occurred in three cases (11%) after crossed pinning in which two had significant palsy, which recovered by three months and the other had only transient paraesthesia.Conclusions: Lateral pinning technique is reliably safe method in terms of stability as it avoids IUNI, we recommend it.

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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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A study comparing two different pinning techniques in supracondylar fractures of the humerus

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl2.2098 ◽

2020 ◽

Vol 11 (SPL2) ◽

pp. 48-53

Author(s):

Yeshwanth Subash ◽

Sugumar Natarajan ◽

Lydia M

Keyword(s):

Ulnar Nerve ◽

Treatment Options ◽

Time Frame ◽

Fracture Reduction ◽

Supracondylar Fractures ◽

Type Iii ◽

Pin Fixation ◽

Significant Difference ◽

Ulnar Nerve Injury ◽

Group B

Various treatment options are available for treating type III supracondylar fractures of the humerus. The most common technique employed is closed manipulative reduction with K wire fixation. This study was performed to compare two different pinning techniques in type III supracondylar fractures of the humerus. This study was done in the time frame between January 2012 to December 2015. The age of the children selected for this study ranged from 3 to 12 years of age. Among 66 children, 6 were lost to follow up and the final number was 60 children. Patients with lateral pin fixation were allotted to group A(n=29), while patients with cross pin fixation technique were allotted to Group B(n=31). All patients were assessed for loss of fracture reduction and the occurrence of ulnar nerve injury. The two groups were evaluated at regular intervals from the first week to a time frame of 6 months. In both groups of patients, there was no loss of fracture reduction observed. The various parameters pertaining to the study were evaluated and there was no statistical significant difference found between the 2 groups. In group B, 3 of the children had injury to the ulnar nerve. Both groups were comparable in terms of fracture healing duration, loss in the reduction of the fracture and the stability provided by the pin constructs. In conclusion, both fixation constructs are comparable in terms of stability, but there are higher chances of iatrogenic injury to the ulnar nerve by using the crossed pinning technique. Hence, we conclude that the lateral pin construct is safer as compared to the cross pin method.

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Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2018.v04i04.22 ◽

2018 ◽

Vol 4 (4) ◽

pp. 519-522

Author(s):

Jeyakumar S ◽

Jagatheesan Alagesan ◽

T.S. Muthukumar

Keyword(s):

Range Of Motion ◽

Frozen Shoulder ◽

Type I ◽

Mean Values ◽

Functional Activities ◽

Group A ◽

The Mean ◽

Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

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Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽

10.1186/s42836-020-00063-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Sanjay Bhalchandra Londhe ◽

Ravi Vinod Shah ◽

Amit Pankaj Doshi ◽

Shubhankar Sanjay Londhe ◽

Kavita Subhedar ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Forgotten Joint Score ◽

Group A ◽

Manipulation Under Anaesthesia ◽

Total Knee ◽

The Mean ◽

Group B ◽

Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

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Comparison of Outcome of Lateral Pinning Versus Medial and Lateral Cross Pinning in Childhood Supracondylar Fractures of Humerus

10.53350/pjmhs211592873 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2873-2875

Author(s):

Mudassar Nazzar ◽

Muhammad Adeel-Ur- Rehman ◽

Rizwan Anwar ◽

Omer Farooq Tanveer ◽

Muhammad Abdul Hanan ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Functional Outcomes ◽

P Value ◽

Supracondylar Fractures ◽

Group I ◽

Pin Fixation ◽

Group Ii ◽

Carrying Angle ◽

Ulnar Nerve Injury

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

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Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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