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

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

Journal of Lumbini Medical College ◽

10.22502/jlmc.v4i1.83 ◽

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.

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

Advances in Orthopedic Surgery ◽

10.1155/2016/9256540 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

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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Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2016.10.006 ◽

2017 ◽

Vol 26 (2) ◽

pp. 299-304 ◽

Cited By ~ 7

Author(s):

Jin Li ◽

DeHao Fu ◽

Chong Yu ◽

ShangYu Wang ◽

RenHao Ze ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Surgical Management ◽

Open Reduction ◽

Supracondylar Fractures ◽

Fractures In Children

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Comparison of outcome of closed reduction and percutaneous pinning and, open reduction and internal fixation with k-wire in Gartland extension type III supracondylar fracture of distal humerus in pediatric population

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i1.22449 ◽

2018 ◽

Vol 1 (1) ◽

pp. 1-3

Author(s):

Bhogendra Bahadur KC ◽

Norman Lamichhane ◽

Chandra Bahadur Mishra ◽

Bharat Bahadur Khatri ◽

Sabita Dhakal

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Closed Reduction ◽

Open Reduction ◽

Operative Procedure ◽

Distal Humerus ◽

Supracondylar Fracture ◽

P Value ◽

Percutaneous Pinning ◽

Type Iii

Background: Supracondylar fracture of the distal humerus is one of the commonest fracture in pediatric age group. Though there is consensus of treating type III fracture operatively, no study has compared the outcome between Closed Reduction and Percutaneous Pinning (CRPP) and Open Reduction and Internal Fixation (ORIF) with k-wire in our setup. Materials and Methods: Retrospective comparison study was done on eighty seven cases of Type III supracondylar fracture of distal humerus underwent operative procedure. Fifty four (54) cases underwent CRPP and 33 cases were managed with ORIF with k-wire, and they were followed up till 6 months post-operatively. Results : The mean time for radiological union in patient who underwent CRPP was 4.37±0.94 weeks and that for the patient who underwent ORIF was 4.45±0.13 weeks, the difference of which was statistically insignificant (p-value >0.05). 83.3% of CRPP group and 78.8% in ORIF group had excellent functional outcome and only 3% in ORIF group had poor functional outcome. Conclusion: Though both the group don’t have significant advantage of functional outcome among each other CRPP with limited attempt should be preferred to ORIF with k-wire for the advantage of avoiding surgical scar and reducing surgery time and exposure to anaesthetic agents.

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Outcome of locking plate fixation for proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160712 ◽

2016 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Neil Rohra ◽

Jimmy Chokshi ◽

Rishi Sanghavi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Evaluation Criteria ◽

Proximal Humerus Fractures ◽

Age Group ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods: We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.Results: The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.Conclusions: PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.

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Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202050 ◽

2020 ◽

Vol 6 (4) ◽

pp. 666

Author(s):

Vikram Goud ◽

Manoj Kanamarlapudi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Functional Result ◽

Dash Score ◽

Statistical Relationship ◽

Radiological Outcome ◽

Distal Extremity ◽

The Mean ◽

Barton Fracture

Background: The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.Methods: Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.Results: All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p<0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.Conclusions: The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.

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Treatment of femoral fractures in children aged two to six

The Bone & Joint Journal ◽

10.1302/0301-620x.102b8.bjj-2019-1060.r3 ◽

2020 ◽

Vol 102-B (8) ◽

pp. 1056-1061 ◽

Cited By ~ 1

Author(s):

J. Eric Gordon ◽

John T. Anderson ◽

Perry L. Schoenecker ◽

Matthew B. Dobbs ◽

Scott J. Luhmann ◽

...

Keyword(s):

Intramedullary Nailing ◽

Femoral Fractures ◽

Age Group ◽

Spica Casting ◽

Flexible Intramedullary Nailing ◽

Fractures In Children ◽

Significant Difference ◽

The Family ◽

Intramedullary Stabilization ◽

The Mean

Aims Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group. Methods Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children’s hospitals. Either early closed reduction with spica cast application or flexible intramedullary nailing was accomplished under general anaesthesia. The treatment method was selected after discussion of the options by the surgeon with the family. Data were prospectively collected on patient demographics, fracture characteristics, complications, pain medication, and union. The Impact on Family Scale was obtained at the six-week follow-up visit. In all, 75 patients were included in the study: 39 in the spica group and 36 in the nailing group. The mean age of the spica group was 2.71 (2.0 to 6.9) years and the mean age of the nailing group was 3.16 (2.0 to 6.9) years. Results All fractures healed without evidence of malunion or more than 2.0 cm of shortening. The mean Impact on Family score was 70.2 for the spica group and 63.2 (55 to 99) for the nailing group, a statistically significant difference (p = 0.024) in a univariate analysis suggesting less impairment of the family in the intramedullary nailing group. There was no significant difference between pain medication requirements in the first 24 hours postoperatively. Two patients in the spica group and one patient in the intramedullary nailing group required additional treatment under anaesthesia. Conclusion Both early spica casting and intramedullary nailing were effective methods for treating femoral fractures in children two to six years of age. Intramedullary stabilization provides an option in this age group that may be advantageous in some social situations that depend on the child’s mobility. Fracture treatment should be individualized based on factors that extend beyond anatomical and biological factors. Cite this article: Bone Joint J 2020;102-B(8):1056–1061.

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Medial versus Posterior Triceps Splitting Approach in Open Reduction Internal Fixation of Displaced Supracondylar Fracture of Humerus

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i1.2326 ◽

2020 ◽

Vol 18 (1) ◽

pp. 41-46

Author(s):

Poojan K Rokaya ◽

Dhan Bahadur Karki ◽

Mangal Rawal ◽

Deoman Limbu ◽

Javed Ahmed Khan ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Statistical Significance ◽

Open Reduction Internal Fixation ◽

Supracondylar Fracture ◽

Radiological Outcome ◽

Medial Approach ◽

Clinical And Radiological Outcome ◽

Radiological Union

Background: The purpose of this study is to compare the clinical and radiological outcome of medial versus posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children.Methods: A retrospective review of total 70 children with medial approach (n=30) and posterior triceps splitting approach (n=40) children was made. Time to radiological union, postoperative Bauman’s angle and Lateral humerocapitellar angle was compared for radiological outcome. Cosmetic and functional outcome was assessed and compared using Flynn’s criteria. Results: Radiological parameters like time to union, postoperative Bauman’s angle and Lateral humerocapitellar angle were similar and non-significant between medial and posterior triceps splitting approach. Flynn’s cosmetic outcome was similar between these approach (p=0.198). Loss of ROM was significant in posterior triceps splitting approach (p=0.00). Flynn’s functional outcome was better with medial approach as compared to posterior triceps splitting approach with statistical significance (p=0.00). Conclusions: Medial approach has better functional outcome compared to posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children.Keywords: Children; Humerus; Open reduction; Supracondylar

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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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Closed Reduction and Percutaneous Pinning in the Treatment of Humeral Distal Metaphyseal-Diaphyseal Junction Fractures in Children: A Technique Note and Preliminary Results

Frontiers in Pediatrics ◽

10.3389/fped.2021.670164 ◽

2021 ◽

Vol 9 ◽

Author(s):

Hai Zhou ◽

Ge Zhang ◽

Ming Li ◽

Xing Liu ◽

Xiangyang Qu ◽

...

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Distal Humerus ◽

The Novel ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Radiographic Outcomes ◽

Fractures In Children ◽

Group A ◽

Group B

Objective: The metaphyseal-diaphyseal junction (MDJ) fracture is an uncommon but problematic type of fracture occurring at the distal humerus in children. Closed reduction and fixation are challenging and may not be possible with the conventional reduction maneuver utilized in supracondylar fractures. The purpose of this study was to evaluate a novel closed reduction and percutaneous pinning (CRPP) technique for the treatment of these fractures.Methods: We retrospectively evaluated 14 children (8 boys and 6 girls) who underwent closed reduction and percutaneous fixation for the treatment of MDJ fractures. Six children who underwent treatment with a novel CRPP technique were enrolled as Group A. Eight children underwent the conventional reduction maneuver utilized in supracondylar fracture and were enrolled as Group B. Clinical and radiographic outcomes in the two groups were then compared.Results: In Group A, all six MDJ fractures were treated successfully with the novel CRPP technique without the need for open procedures or re-operation. No complications such as pin-site infection or iatrogenic nerve injury were found in this group. In group B, five of the eight fractures were treated successfully with the conventional CRPP technique; three fractures needed open reduction, and one of them had further surgery because of the loss of fixation. Children with successful CRPP in each group were included to compare the efficacy of the novel CRPP technique. The average duration of the surgery in Group A was significantly shorter than that in Group B (p < 0.001). At last follow-up, both groups obtained satisfactory clinical and radiographic outcomes.Conclusion: MDJ fractures can be reduced successfully and fixed stably via a novel CRPP technique, and laborious and frustrating attempts at closed reduction and further open reduction can be avoided.

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