Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures

Background and objectives: Supracondylar humerus fractures are common in children andcan be surgically treated. However, the general surgical procedures involving reduction andfixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desiredposition, prolonged surgery, or chondral damage. This study aimed to show that temporaryfixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerusfractures could maintain reduction so that surgical treatment can be easily performed by a singlephysician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerusfractures who underwent surgical treatment between May 2017 and June 2018 were retrospectivelyevaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of theforearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pinswere applied on the fracture line by first inserting a lateral-entry K-wire and then inserting anotherK-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nervetunnel. A tourniquet was not applied in any patient and no patients required open reduction.Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years).The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks,respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia wasdetected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes wereexcellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation ofthe closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration ofpinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerusfractures that require surgical treatment with a fabric adhesive bandage may be significantlyconvenient in practice.

Download Full-text

One-year follow up of pediatric supracondylar humerus fractures with bone fragments

10.21203/rs.2.17771/v1 ◽

2019 ◽

Author(s):

Lei Yang ◽

Lang Li ◽

Panyi Yang ◽

Xueyang Tang

Keyword(s):

Clinical Outcome ◽

Range Of Motion ◽

Closed Reduction ◽

X Ray ◽

Supracondylar Humerus Fractures ◽

Bone Fragments ◽

Humerus Fractures ◽

The Mean ◽

Carrying Angle ◽

One Year

Abstract Background The aim of this study is to evaluate the clinical and imaging outcome of pediatric supracondylar humerus fractures with bone fragments on X ray film after closed reduction and percutaneous pin fixation.Methods A retrospective review of 12 children with fragments on image after closed reduction treatment for displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included the outcome of the fragments, post-operative Baumann angle, Carrying angle and loss of reduction. The clinical outcome included elbow range of motion, Flynn grade and other complications.Results Totally there were 460 cases of pediatric supracondylar humerus fractures (2-14 years old) treated in our center from January 2015 to January 2018, and 12 (2.6%) of the patients with bone fragments on postoperative X ray film were included. All 12 patients had bone fragments union or absorbed at 1 year after operation with good radiographic and clinical outcome. The mean Baumann angle was 15.5±4.3°, and the mean Carrying angle was 11.2±2.8°. All patients had a normal elbow range of motion, 10 patients obtained an excellent result, and 2 patients were good According to Flynn criteria. Conclusions We have good results for closed reduction and percutaneous pin fixation treatments in 12 pediatric supracondylar humerus fractures with bone fragments. The fragments were mainly absorbed or union to humerus in one year after surgery.

Download Full-text

Our Early Term Surgical Treatment Results in Pediatric Gartland Type 3 Supracondylar Humerus Fractures

Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi ◽

10.5222/jopp.2013.027 ◽

2013 ◽

Vol 5 (1) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

Mehmet Erdil ◽

Hasan Huseyin Ceylan ◽

Necdet Demir ◽

Nuh Mehmet Elmadag ◽

Kerem Bilsel ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Results ◽

Early Term ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures ◽

Type 3

Download Full-text

The Outcome of Closed Reduction and Total Lateral Entry Crossed Pin Fixation of Unstable Type III Pediatric Supracondylar Humerus Fractures

Journal of Orthopedic and Spine Trauma ◽

10.5812/jost.10407 ◽

2016 ◽

Vol In Press (In Press) ◽

Author(s):

Hossein Aslani ◽

Amirmohammad Navali ◽

Taghi Baghdadi ◽

Reza Abdy

Keyword(s):

Closed Reduction ◽

Lateral Entry ◽

Type Iii ◽

Pin Fixation ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures ◽

Unstable Type

Download Full-text

A study on outcome of various K-wire fixations in paediatric supracondylar humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203525 ◽

2020 ◽

Vol 6 (5) ◽

pp. 896

Author(s):

Shalin Bharat Shah ◽

Kushal Nikhil Parikh ◽

Pradipkumar Ishvarbhai Paraliya

Keyword(s):

Functional Outcome ◽

Cosmetic Outcome ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Lateral Entry ◽

Supracondylar Humerus Fractures ◽

Pin Geometry ◽

Humerus Fractures ◽

The Mean

Background: The ideal pin geometry for treatment of paediatric supracondylar humerus fracture is still debated. Various studies have been carried out comparing medial-lateral pinning (MLP) and lateral only pinning (LOP), but none have compared all three individually i.e. MLP, lateral divergent pinning and Lateral Trans olecranon fossa four cortex purchase pinning (TOF-FCP). This study aims to compare the cosmetic and functional outcome of these three pinning methods.Methods: 54 children with supracondylar humerus (Gartland type 2 or 3) meeting inclusion criteria were treated operatively and followed up till 6 months postoperatively. At 6 months the cosmetic and functional outcomes were assessed using the modified Flynn criteria.Results: All fractures united within 3 to 6 weeks duration. The mean duration of fracture union was 4.05 weeks. Functional outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent pinning. cosmetic outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent.Conclusions: Functional and cosmetic outcome of all three pinning geometries after operative intervention of paediatric supracondylar humerus fracture is similar in expert hands. The incidence of complications with TOF-FCP construct is less amongst the lateral only pinning.

Download Full-text

The Outcome of Surgical Treatment of Multidirectionally Unstable (Type IV) Pediatric Supracondylar Humerus Fractures

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000344 ◽

2015 ◽

Vol 35 (6) ◽

pp. 600-605 ◽

Cited By ~ 6

Author(s):

Mauricio Silva ◽

Shannon D. Cooper ◽

Angela Cha

Keyword(s):

Surgical Treatment ◽

Type Iv ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures ◽

Unstable Type

Download Full-text

Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04717-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Gang Chen ◽

Lu Cui ◽

Jiaqi Shi ◽

Peng Zhang ◽

Jun Li ◽

...

Keyword(s):

Articular Surface ◽

Operation Time ◽

Contralateral Side ◽

Gender And Age ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Reliable Parameter ◽

Cosmetic Outcomes ◽

Humerus Fractures

Abstract Background The supracondylar humerus fractures are the most common fracture in children’s elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. Methods We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn’s grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn’s grading scores were compared between groups. Results A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn’s grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). Conclusions There was no significant difference in reduction quality and Flynn’s scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.

Download Full-text

Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

Journal of International Medical Research ◽

10.1177/0300060518797022 ◽

2018 ◽

Vol 47 (1) ◽

pp. 133-141

Author(s):

Barak Rinat ◽

Eytan Dujovny ◽

Noam Bor ◽

Nimrod Rozen ◽

Guy Rubin

Keyword(s):

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Closed Reduction ◽

Open Reduction ◽

High Grade ◽

Supracondylar Humerus Fractures ◽

Long Term Follow Up ◽

Humerus Fractures ◽

Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

Download Full-text