Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning

Supracondylar fractures of humerus in children are common injuries. Displaced fractures areinherently unstable. Conservative treatment results in malunion. Open reduction and internalfixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102displacedsupracondylarfractures of humerus, agedbetween one andhalf yearto 13 years, weretreated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wireswereput.Above elbow plaster ofparis back slab was appliedinall cases for atleastfour weeks.Backslab,K-wireswere removedafterfourweeks andelbowrangeofmotionexercisewas started.Resultswere analyzed using Flynn’s criteria. All patients were followed up to 14th week postoperatively. Incross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively.We recommend this procedure fordisplacedsupracondylarfractures inchildrenas itis safeandcost effectiveprocedurewithacceptablecomplication rates.Key words: closed reduction, humerus, percutaneous pinning, supracondylar fracture

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Minimally Invasive-Closed Reduction and Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v1i2.16639 ◽

2015 ◽

Vol 1 (2) ◽

pp. 15-18

Author(s):

Nabees Man Singh Pradhan ◽

Rojan Tamrakar ◽

Bidur Gyawali ◽

Toya Raj Bhatta ◽

Balakrishnan M. Acharya ◽

...

Keyword(s):

Minimally Invasive ◽

Closed Reduction ◽

Invasive Technique ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Ulnar Nerve Injury ◽

K Wires ◽

Pin Tract Infection ◽

Tissue Trauma ◽

Minimally Invasive Reduction

Introductions: Although Closed Reduction and Percutaneous Pinning is the gold standard of treatment for Supracondylar fractures (SC) in children, reduction is not always easy. Minimally Invasive, Closed Reduction and Percutaneous Pinning (MI-CRPP) reduces the soft tissue trauma and provides easy reduction. We have reviewed the success rate of minimally invasive reduction technique and its outcome.Methods: We reviewed the charts of 155 children (97 male, 58 female) age ranging from 2 to 14 years with SC fractures of the humerus who were operated with minimally invasive closed reduction and precutaneous pinning from November 2008 to June 2014 at Patan Hospital and Om Hospital. They were followed up for a mean of eight (4 to 24) weeks. The K-wires were removed at 4 to 6 (average 4.28) weeks.Results: Male children were affected more than female with the ratio being 97 to 58. Right side was affected more than left (ratio 89 to 66). Post-operatively, there were six (3.87%) ulnar nerve injury and eight (5.16%) patients came with superficial pin tract infection. One hundred and thirteen (72.9%) had excellent, 35 (22.58%) good, five (3.23%) fair and two (1.3%) poor results at the eight week follow-up which was improved to 144 (92.9%) excellent, seven (4.5%) good, three (1.9%) fair and one (0.65%) poor results at the 14 week follow-up.Conclusions: Closed reduction of supracondylar fractures of the humerus in children with minimally invasive technique prior to K-wire fixation is a relatively simple, safe and effective method of achieving satisfactory reduction and good functional outcome.

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Comparison of closed reduction and percutaneous cross verses parallel k wire fixation in supracondylar fractures of the humerus in children.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3091 ◽

2020 ◽

Vol 27 (03) ◽

pp. 476-480

Author(s):

Farhan Majeed ◽

Mudasser Saddique ◽

Hafiz Nasir ◽

Ahmad Shams

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Closed Reduction ◽

Functional Results ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Wire Fixation ◽

Group A ◽

Ulnar Nerve Injury ◽

K Wires

Around the elbow, supracondylar injury of humerus is one of the conventional fractures which usually occurs at the age of 7 to 8 years. Various conservative techniques have been used for the management, which comprises of the splintage, tractions, open or closed reduction with k wire fixation. However, closed reduction and percutaneous pinning remains the mainstay of surgical management, for they have shown splendid outcomes according to many authors. Objectives: The aim of this study is to summarise and compare the radiological and functional results of two ways of fixation (cross and parallel closed K wires) of supracondylar fractures in children. Study Design: Randomized controlled trial. Setting: Department of Orthopaedics Surgery, Services Hospital, Lahore. Period: 1st January 2018 to 31st June 2018. Material & Methods: We included 180 patients (90 in each group). Results: The mean age was 6.45±2.34 years with 115(63.9%) male and 65(36.1%) female. Among the children who underwent fixation with cross k-wires, ulnar nerve injury was seen in 2(2.2%) cases and none were seen in the other group post operatively. Group A attained higher union rate at last follow up. 4(4.4%) cases in Cross K-wires and 19(21.1%) in two lateral k-wires gave outstanding outcome. In a nutshell, 60 in group A and 45 in group B showed excellent outcomes based on Flynn's criteria, p-value < 0.05. Conclusion: According to Flynn’s criteria, closed percutaneous cross K-wire fixation of supracondylar fracture of humerus is an effective management option in terms of finer functional results as compared to Parallel k-wires. Although, the rate of radiological union is higher in cross k-wire fixation, there are 2.2% chances of ulnar nerve injury.

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Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22034 ◽

2019 ◽

Vol 10 (2) ◽

pp. 58-61

Author(s):

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pabin Thapa ◽

Upendra Jung Thapa ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Distal Humerus ◽

Supracondylar Fracture ◽

Good Stability ◽

Lateral Side ◽

Supracondylar Fractures ◽

Wire Fixation ◽

Ulnar Nerve Injury ◽

K Wires

Background: Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability. Materials and Methods: This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture. Result: Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups. Conclusion: Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

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Close Reduction and Percutaneous K-wire Fixation without Image Intensifier in Supracondylar Fracture of Humerus in Children

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i1.9321 ◽

2013 ◽

Vol 3 (1) ◽

pp. 19-22

Author(s):

Ruhullah Mohammad ◽

Sanjay Kumar Ranjan Shah ◽

HR Singh ◽

KD Sinha ◽

Dipan Barua ◽

...

Keyword(s):

Closed Reduction ◽

Case Series ◽

Image Intensifier ◽

Cost Effective ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Gold Standard Method ◽

Remote Hospital ◽

Wire Fixation ◽

One Year

Introduction: Extension Type III supracondyla fractures of the humerus is most common fractures around the elbow in children. Closed reduction and percutaneous pinning under image intensifier guide has been the gold standard method of treatment. However, image intensifier is not readily available in most part of our country. Closed reduction and percutaneous pinning is possible even without image intensifier. we report our case series of 51 cases who underwent closed reduction and percutaneous pinning without image intensifier. Methods: Between November 2009 and April 2011 a total of 51 children with a displaced supracondylar fractures of the humerus were managed by close reduction and percuteneus k-wire fixation without using image intensifier. They were followed for a period of minimum 6 months up to one and a half years (average one year) and the final outcome was assessed using functional and cosmetic criteria used by Flynn and associates. Results: Of these 51 patients, 46 (90%) patients showed an excellent results. Satisfactory results were achieved in 4 (8%) patients, poor in 1(2%) patients. Conclusion: Close reduction and percutaneous K-wire fixation without using image intensifier is radiation free, cost effective and relatively safe method of management of displaced supracondylar fractures of humerus in children. It can be used in a remote hospital where the facilities of image intensifier or portable x-ray are not available. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9321 Nepal Orthopedic Association Journal 2013 Vol.3(1): 19-22

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Type-III supracondylar humerus fracture: functional outcome of open reduction and internal fixation after failed closed reduction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205561 ◽

2020 ◽

Vol 7 (1) ◽

pp. 62

Author(s):

Shobha H. P. ◽

Vishwas K. ◽

Lingaraju K. ◽

Giridhar Kumar

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Supracondylar Fractures ◽

Orthopaedic Department ◽

Type Iii ◽

Medical College ◽

K Wires ◽

Age Range

Background: To evaluate results of open reduction and internal fixation with Criss cross k-wires after failed closed reduction in Gartland type III Supracondylar fracture of humerus in our institution.Methods: This prospective study was conducted at the Krishna Rajendra hospital affiliated to the orthopaedic department of Mysore medical college and research institute from December 2018 to December 2019. Twenty-five patients of type-III fracture of supracondylar humerus were included within the study. Consent was obtained from all patients. Under anaesthesia, closed reduction was attempted first. When 2-3 attempts of closed reduction failed, an open reduction and internal fixation with cross k-wires was performed. Fortnightly follow up was applied for the first 8 weeks then monthly for the next 4 months. The clinical outcome was evaluated using Flynn criteria.Results: Out of 25 patients, 16 were male and 9 were female. Left side was involved in 17 patients and right side in 8. Mean age was 6.9 years with age range from 3 to 12 years. Excellent or good results were obtained in 23 (92%) patients and fair or poor in 2 (8%). Conclusions: We conclude that these fractures must be managed aggressively, by a specialised surgeon. Open reduction and internal fixation of severely displaced supracondylar fractures of the humerus is a safe and effective method when a satisfactory reduction can't be obtained by 2-3 attempts on closed method.

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Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers: reduction and K-wire fixation leaving the metacarpophalangeal and proximal interphalangeal joints free

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411405943 ◽

2011 ◽

Vol 36 (7) ◽

pp. 577-583 ◽

Cited By ~ 10

Author(s):

Mohammad M. Al-Qattan

Keyword(s):

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Industrial Workers ◽

Active Motion ◽

Wire Fixation ◽

Total Active Motion ◽

K Wires ◽

Pin Tract Infection ◽

Transverse Fractures

A series of 35 adult male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were treated with reduction and K-wire fixation leaving the metacarpophalangeal and interphalangeal joints free to move immediately after surgery. At final follow-up, the total active motion score of the injured finger was graded as excellent, good, fair, or poor if it was greater than 240°, 220–240°, 180–219°, or less than 180°, respectively. Complications were also documented. The results were compared with our previously published series of these fractures treated with two other techniques: percutaneous K-wires immobilizing the metacarpophalangeal joint and open reduction and interosseous loop wire fixation. The final TAM scores in the current study were excellent in 43%, good in 29%, fair in 14% and poor in 14%. Four out of the 35 patients (11%) had minor pin tract infection. These results were significantly better than the results following percutaneous K-wire fixation immobilizing the metacarpophalangeal joint indicating that immediate mobilization of all joints has a significant effect on the outcome.

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Study of percutaneous K wire fixation in supracondylar fracture of humerus in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191556 ◽

2019 ◽

Vol 5 (3) ◽

pp. 427

Author(s):

Putappa Gopinath ◽

Sabneet Singh ◽

Abdul Ravoof

Keyword(s):

Functional Outcome ◽

Closed Reduction ◽

Distal Humerus ◽

Percutaneous Pinning ◽

Supracondylar Fractures ◽

Anatomical Reduction ◽

Fractures In Children ◽

Wire Fixation ◽

Carrying Angle ◽

Loss Of Motion

Background: Closed reduction is difficult not only to achieve but also to maintain because of the thinness of bone of the distal humerus between the coronoid and olecranon where most supracondylar fractures occurs. For this reason percutaneous pinning techniques have become the treatment of choice for most supracondylar fractures. By this procedure even the displaced and rotated fracture can be treated successfully with minimal incidence of complications. The purpose of this study is to determine the efficacy of management of displaced supracondylar fractures using closed reduction with percutaneous K-wire pinning and to analyze the results, loss of carrying angle, and loss of motion with incidence of complications.Methods: 20 cases of displaced supracondylar fractures in children aged between 5 and 12 years were treated by closed reduction and percutaneous pinning and were studied prospectively for functional outcome. 8 cases were treated with crossed pinning. 11 cases were treated with 3K wire fixation and 1 with lateral pinning.Results: 85% of the patients observed excellent results. 15% of the patients observed fair results. Of the cases treated by 3K wire fixation 55% had excellent results and cases with crossed pinning 40% had good results and 5% had poor results. All the patients treated with lateral pinning had excellent results.Conclusions: The results obtained in this study shows that anatomical reduction by closed method and stabilization with K-wire fixation is the first treatment of choice for displaced supracondylar fractures.

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Supracondylar fracture, buried vs non buried K wires.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3052 ◽

2020 ◽

Vol 27 (03) ◽

pp. 467-471

Author(s):

Usama Bin Saeed ◽

Muhammad Waseem ◽

Allah Rakha Hassan ◽

Zeeshan Ali Khan ◽

Dilshad Gill ◽

...

Keyword(s):

Tract Infection ◽

Internal Fixation ◽

Open Reduction ◽

Supracondylar Fracture ◽

Supracondylar Fractures ◽

Elbow Fractures ◽

Group A ◽

K Wires ◽

Pin Tract Infection ◽

Group B

Supracondylar fracture of the humerus is the second most common fracture in children (16.6%), and is most common fracture around the elbow in children comprise (60%) to (75%) of all elbow fractures. There is very little data available about the burier of wires under the skin reduces the pin tract infection rate as low as 2.27%.2 Objectives: To compare the frequency of pin tract infection between nonburied and buried K-wires after open reduction internal fixation in supracondylar fracture of humerus in children. Study Design: Prospective Cohort Study. Setting: Department of Orthopedics Surgery & Traumatology Allied Hospital Faisalabad. Period: From June 2014 - June 2017. Material & Methods: Patients were selected according to the inclusion criteria. All patients were registered in ER with a history of trauma and having the diagnosis of Supracondylar fracture. Two groups were made; Group A (Buried), Group B (Non-buried). They were followed for the signs of infection. Results: Out of 80 cases 45 (56.3 %) were male and 35 (43.8 %) female. In group A (non-buried) there were 40 patients and Mean age was 7.57± 2.07 years, pin tract were infected in 8 (20%) patients and there were no pin tract infection in 32 (80%) patients. And in group B (buried) there were 40 patients and mean age was 7.38± 2.17 years, Pin tract was infected in 1(2.5%) patient and there were no pin tract infection in 39(97.5%). Conclusion: Our study showed that rate of infection is significantly reduced in burying of K-wires after open reduction and internal fixation of supracondylar fractures as compared to non-burying technique.

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A clinical study of closed reduction and percutaneous Kirschner wire fixation of displaced supracondylar fractures of humerus in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170787 ◽

2017 ◽

Vol 3 (2) ◽

pp. 282

Author(s):

Mohammad Asimuddin ◽

Raju H. Kulkarni

Keyword(s):

Closed Reduction ◽

Kirschner Wire ◽

Fracture Pattern ◽

Supracondylar Fractures ◽

Female Ratio ◽

Lateral Entry ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

K Wires

Background: Supracondylar fractures of the humerus are the most common fracture pattern of the elbow in children. Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. The purpose of this study was to evaluate the results of stabilization of these fractures by closed reduction and percutaneous Kirschner wire fixation.Methods: Thirty cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patient was 8.3 years [ranges from 4-14 years]. The male to female ratio was 2:1 and left side was involved in 23 cases whereas 7 had right sided injuries. All fractures were of extension type [Gartland’s type III]. Posteromedial displacement was noted in 22 cases whereas 8 fractures were posterolaterally displaced. In 20 cases, lateral entry wires alone were used whereas in 10 cases one lateral and one medial K-wire were used. K- wires were removed after 3 weeks post-operatively and follow-up was done at 6 weeks,12 weeks, 6 months and 12 months, when they were evaluated according to Flynn’s criteria.Results: Results were graded using Flynn’s criteria. Excellent results were achieved in 18 [60%], good in 6 [20%] fair in 4 [13.3%], while poor results were seen in 2 [6.7%] patients.Conclusions: Closed reduction and percutaneous fixation using Kirschner wires is a safe and efficient method for fixation of displaced supracondylar fractures of the humerus in children.

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Comparison of Outcome of Lateral K-Wire Fixation Verses Medio-Lateral Crossed K-Wire Fixation for Displaced Extension Type of Supracondylar Humeral Fractures in Children

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v2i3.11823 ◽

2014 ◽

Vol 2 (3) ◽

pp. 20-25 ◽

Cited By ~ 1

Author(s):

HK Gupta ◽

D Chaurasia

Keyword(s):

Closed Reduction ◽

P Value ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Pin Fixation ◽

Wire Fixation ◽

Supracondylar Humeral Fractures ◽

Group A ◽

Ulnar Nerve Injury ◽

Group B

INTRODUCTION: Supracondylar humeral fractures are the most common elbow fractures seen in children. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of displaced extension supracondylar fractures of the humerus in children. MATERIAL AND METHODS: Total of 50 cases of displaced supracondylar fracture humerus were enrolled in study, 25 cases in two equal groups, Group A and group B. Group A received treatment by closed reduction with lateral k-wire fixation and Group B received treatment by closed reduction and medio-lateral k-wire fixation. The cases were followed at 4 weeks when slab was removed and physiotherapy started, and at 12 weeks for final outcome. The outcome was measured as per Flynn's criteria.RESULTS: The mean age of patents in group A was 6.40 years and in group B was 6.44 years. At final follow up, in group A, 18 (72%) cases had excellent, 7 (28%) good result, in group B; 20 (80%) had excellent, and 5 (20%) had good result. The p- value (0.08) derived between them was statistically not significant. Three pateints got superficial pin tract infection in group A and two iatrogenic ulnar nerve injury and one pin had pintract infection in group B. There were also no significant differences (p value- 0.697) between groups with respect to the baumann angle. CONCLUSION: Both lateral entry pin fixation and medio- lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children. Although there remains subtle risk of ulnar nerve injury in medio-lateral pin fixation.DOI: http://dx.doi.org/10.3126/jucms.v2i3.11823 Journal of Universal College of Medical Sciences Vol.2(3) 2014: 20-25

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