scholarly journals Prevalence and Treatment Outcome of Displaced High-Long Oblique Supracondylar Humeral Fractures in Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Mudit Shah ◽  
Joo Hyung Han ◽  
Hoon Park ◽  
Hyun Woo Kim ◽  
Kun-Bo Park
Keyword(s):  
Direct Contact ◽  
Statistical Significance ◽  
Treatment Protocol ◽  
Humeral Fracture ◽  
Fracture Line ◽  
Percutaneous Pinning ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Supracondylar Humeral Fractures

Aim: The treatment protocol for supracondylar humeral fracture has mainly been based only on the severity of displacement and percutaneous pinning has been recommend as a first treatment. However, a long oblique fracture line is difficult to fix by the traditional cross pinning. The purpose of this study is to assess the prevalence of high-long oblique supracondylar humeral (HLO) fracture and evaluate the surgical outcome of percutaneous pin fixation.Methods: We reviewed 690 children who had undergone an operation for the displaced supracondylar humeral fracture. HLO fracture was defined as having a fracture line starting from either cortex above the metaphyseal-diaphyseal junction and finishing at the opposite cortex around or below the olecranon fossa. Clinical and radiographic parameter outcomes were assessed.Results: There were 14 patients diagnosed with the HLO fracture (14/690) and all the patients were treated by pin fixation. The median age was 5 years 1 month (range, 2–11 years). The common mode of injury was direct contact injury to the elbow. There were 6 patients with lateral HLO fracture, and 8 patients had medial HLO type. In medial HLO type, medial pinning only was done in 3 patients due to the difficulty in lateral pin insertion. In addition, the lateral pin was not a bicortical fixation through capitellum entry in 2 patients who had it fixed by cross pinning. The final Baumann angle and lateral humero-capitellar angle were 20.5 (5–67.6) degrees and 49.3 (23.3–71.9) degrees, respectively, without statistical significance compared to the normal side. Flynn's cosmetic grade showed satisfactory results in all patients.Conclusion: The prevalence of HLO fractures was 2% in the displaced supracondylar humeral fracture. The mechanism of injury of HLO fractures may be direct contact injury. In medial HLO fractures, medial pinning is important for stability, and sometimes lateral pinning was impossible. Contrarily, lateral HLO fracture could easily be fixed by lateral-only pinning, but the correct lateral pinning is necessary because medial pinning is difficult. The HLO fracture is a difficult pattern to treat by traditional percutaneous pinning and another surgical option should be considered.

scholarly journals Supracondylar fracture humerus (Gartland Type III) managed with closed reduction and percutaneous pinning (CRPP) in children.

2020 ◽  
Vol 27 (06) ◽  
pp. 1092-1096
Author(s):  
Masroor Ahmed ◽  
Badaruddin Sahito ◽  
Rukhsana Hamid ◽  
Nida ◽  
Mukesh Kumar ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Humeral Fracture ◽  
Functional Results ◽  
Treatment Method ◽  
Clinical Results ◽  
Percutaneous Pinning ◽  
Supracondylar Humeral Fracture ◽  
Type Iii ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures

Objectives: The objective of this study is to assess the functional outcome of close reduction and percutaneous K- wire fixation in supracondylar humeral fracture (SCHF) Gartland type III fractures in children. Study Design: Experimental study. Period: January 2017 to December 2017. Setting: Department of Orthopedics Civil Hospital Karachi. Material & methods: 60 children sustaining a Gartland type III supracondylar humerus fractures less than 1 week old that was treated by closed reduction and percutaneous pinning. Clinical results were evaluated using the Flynn’s criteria. Results: All the 60 children with Gartland type III supracondylar humerus fracture included in this study. 42 (70%) boys and 18 (30%) girls with age ranging between 2 to 10 years .Right side was involved in 37(62%) and left side was involved in 23 (38%) patients. All patients are of extension type fracture. According to Flynn’s criteria cosmetic results were excellent in 54 (90%) and good in 6 (10%) patients and functional results were excellent in 54 (90%), good in 4(7%), fair in 2 (2%) and poor in 1(1%) patient. One patient ulnar nerve injury, after 3 months nerve explored that was contused, symptoms resolved afterwards. Conclusion: Close reduction and percutaneous fixation with K-wire in Gartland III fracture in children is safe and effective treatment method with minimal hospital stay and less complications.

scholarly journals Intra-Articular Bupivacaine Injection is An Ideal Method for Postoperative Pain Control in Children with Supracondylar Humeral Fracture

2021 ◽  
Author(s):  
Qian Wang ◽  
Jingxin Zhao ◽  
Yu Wang ◽  
Man He
Keyword(s):  
Treatment Group ◽  
Postoperative Pain ◽  
Pain Control ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

Abstract Objective: Supracondylar humeral fracture is the most common fracture in children. Currently there are a large number of studies on supracondylar humeral fractures addressing the epidemiology of supracondylar fractures, injury mechanisms, treatments and complications, however there are few studies on how to control the pain in children after fractures and operation. Therefore, we retrospectively analyzed the effectiveness of an intra-articular injection of 0.25% bupivacaine on pain control after CRPP of supracondylar humeral fractures in children. To our knowledge, this is the largest study on the use of an intra-articular injection for pain control after surgery for supracondylar humeral fractures.Methods: This clinical trial was designed to evaluate the efficacy of intra-articular injection of 0.25% bupivacaine as a postoperative pain control in children with supracondylar humeral fractures who underwent closed reduction and percutaneous pinning (CRPP).Subjects (n = 120) were randomized to treatment with 0.25% bupivacaine (treatment group) (n = 60) or no injection (control group) (n =71). After surgery, all patients were prescribed Ibuprofen for analgesia. The Ibuprofen doses and the times of administration were recorded. The Faces Pain Scale-Revised (FPS-R) scores were blindly recorded during postoperative day 1.Results: The results suggested that the use of intra-articular injection of 0.25% bupivacaine improved pain control and decreased the need for Ibuprofen on postoperative day 1. FPS-R scores were also significantly lower in the treatment group as compared with those of the control group. No intra-articular injection-associated complications were reported. Conclusion: Therefore, the intra-articular injection of bupivacaine significantly improves postoperative pain control following CRPP of supracondylar humeral fractures in children.

scholarly journals Treatment of Flexion-Type Supracondylar Humeral Fracture in Children

2007 ◽  
Vol 15 (2) ◽  
pp. 174-176 ◽  
Author(s):  
B Garg ◽  
A Pankaj ◽  
R Malhotra ◽  
S Bhan
Keyword(s):  
Closed Reduction ◽  
Humeral Fracture ◽  
Type I ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Activity Restriction ◽  
Supracondylar Humeral Fracture ◽  
Results Of Treatment ◽  
Good Treatment Option ◽  
One Year

Purpose. To assess the results of treatment for flexion-type supracondylar humeral fracture in children. Methods. The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. Severity was classified according to the Gartland system for extension-type fractures. Type-I fractures were treated with immobilisation in an extension cast. For type-II and -III fractures, closed reduction was first attempted followed by percutaneous pinning. If closed reduction failed, open reduction and internal fixation was performed. Results. Patients were followed up for at least one year (range, 14–36 months). Treatment results were excellent in 7 patients, good in 4, fair in 3, and poor in none. Patients were pain-free and satisfied and none suffered any activity restriction. Conclusion. Closed reduction and percutaneous pinning is a good treatment option for type-II and -III flexion-type supracondylar humeral fractures.

scholarly journals Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 573
Author(s):  
Komang Agung Irianto ◽  
I Putu Gede Pradnyadewa Pradana ◽  
Brigita De Vega
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Humeral Fracture ◽  
Lateral Approach ◽  
Surgical Approaches ◽  
Eligibility Criteria ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Cosmetic Outcomes

Background: Supracondylar humeral fracture (SHF) is the most common type of fracture in children. Moreover, lateral and posterior surgical approaches are the most frequently chosen approaches for open reduction surgery in displaced SHF when C-arm is unavailable. However, previous literature showed mixed findings regarding functional and cosmetic outcomes. Currently, no systematic review and meta-analysis has compared these two procedures.  Methods: Our protocol was registered at PROSPERO (registration number CRD42021213763). We conducted a comprehensive electronic database search in MEDLINE, EMBASE, and CENTRAL. Two independent reviewers screened the title and abstract, followed by full-text reading and study selection based on eligibility criteria. The quality of the selected studies was analyzed with the ROBINS-I tool. Meta-analysis was carried out to compare the range of motion (functional outcome) and cosmetic outcome according to Flynn’s criteria. This systematic review was conducted based on PRISMA and Cochrane handbook guidelines.  Results: Our initial search yielded 163 studies, from which we included five comparative studies comprising 231 children in the qualitative and quantitative analysis. The lateral approach was more likely to result in excellent (OR 1.69, 95% CI [0.97-2.93]) and good (OR 1.12, 95% CI [0.61-2.04]) functional outcomes and less likely to result in fair (OR 0.84, 95% CI [0.34-2.13]) and poor (OR 0.42, 95% CI [0.1-1.73]) functional outcomes compared to the posterior approach. In terms of cosmetic results, both approaches showed mixed findings. The lateral approach was more likely to result in excellent (OR 1.11, 95% CI [0.61-2.02]) and fair (OR 1.18, 95% CI [0.49-2.80]) but less likely to result in good (OR 0.79, 95% CI [0.40-1.55]) cosmetic outcomes. However, none of these analyses were statistically significant (p> 0.05).  Conclusion: Lateral and posterior surgical approaches resulted in satisfactory functional and cosmetic outcomes. The two approaches are comparable for treating SHF in children when evaluated with Flynn’s criteria.

Dynamics of the ulnar nerve after percutaneous pinning of supracondylar humeral fractures in children

2009 ◽  
Vol 18 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Oktay Belhan ◽  
Lokman Karakurt ◽  
Huseyin Ozdemir ◽  
Erhan Yilmaz ◽  
Mehmet Kaya ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Humeral Fractures ◽  
Percutaneous Pinning ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

scholarly journals Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

2011 ◽  
Vol 82 (5) ◽  
pp. 606-609 ◽  
Author(s):  
Robert Eberl ◽  
Christian Eder ◽  
Elisabeth Smolle ◽  
Annelie M Weinberg ◽  
Michael E Hoellwarth ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Humeral Fractures ◽  
Antegrade Nailing ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Supracondylar Humeral Fractures ◽  
Ulnar Nerve Injury

scholarly journals Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches

2016 ◽  
Vol 144 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Sinisa Ducic ◽  
Marko Bumbasirevic ◽  
Vladimir Radlovic ◽  
Petar Nikic ◽  
Zoran Bukumiric ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Type Ii ◽  
Percutaneous Pinning ◽  
Cast Immobilisation ◽  
Fractures In Children ◽  
Supracondylar Humerus Fractures ◽  
Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
Humerus Fractures

Introduction. Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective. The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods. Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn?s criteria. Results. Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion. Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications.

Loss of Pin Fixation in Displaced Supracondylar Humeral Fractures in Children

2007 ◽  
Vol 89 (4) ◽  
pp. 713-717
Author(s):  
Wudbhav N. Sankar ◽  
Nader M. Hebela ◽  
David L. Skaggs ◽  
John M. Flynn
Keyword(s):  
Humeral Fractures ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Supracondylar Humeral Fractures
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