FUNCTIONAL OUTCOME OF CLOSED DISPLACED SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN TREATED WITH CLOSED REDUCTION AND PERCUTANEOUS PINNING – A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 9-11
Author(s):  
Sandeep Ramola ◽  
Prasanth Srinivasan ◽  
Vidyanand M Makani
Keyword(s):  
Observational Study ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Prospective Observational Study ◽  
Supracondylar Fracture ◽  
Elbow Fracture ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Supracondylar Humeral Fractures ◽  
Carrying Angle

Background: Supracondylar humeral fractures are the most common fractures around elbow in children. The incidence is equal in both sexes with left or non-dominant side being most frequently injured. 96 to 98% are extension type and the exion type is far less common. Displaced supracondylar fractures are notorious for difculty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. Material and methods: A prospective observational study was conducted on sixty children with closed displaced supracondylar fracture of humerus treated with closed reduction and k wire xation, between May 2016 and June 2018. Children aged between 3 and 15 years, radiological nding conrming displaced supracondylar fracture of humerus were included in this study. Children with less than 3 years of age, physeal injury or intraarticular extension, open fractures, polytrauma of the same limb, previous fracture of the same elbow, fracture requiring open reduction and inability to give written informed consent were excluded in this study. All patients underwent closed reduction and percutaneous pinning within 24 hours of admission. The functional outcome was measured by the range of motion and carrying angle by using Flynn et al criteria. Results: Of 60 patients, 73.3% had excellent results, 18.3% had good, 5% had fair and 3.3% patients had poor results. Conclusion: Closed reduction and percutaneous pinning under C arm guidance is a simple and effective method of treatment of displaced supracondylar fractures of humerus in children with relatively fewer short term complications.

scholarly journals Functional and Radiological Outcome of Type ΙΙΙ Supracondylar Fracture of Humerus Treated by Crossed Versus Lateral Pinning a Prospective Cohort Study Conducted in a Tertiary Health Care Centre in Thiruvananthapuram, Kerala

2021 ◽  
Vol 8 (26) ◽  
pp. 2300-2305
Author(s):  
Anand Narayanan ◽  
Subramanian Vaidyanathan
Keyword(s):  
Cohort Study ◽  
Functional Outcome ◽  
Prospective Cohort Study ◽  
Closed Reduction ◽  
Prospective Cohort ◽  
Supracondylar Fracture ◽  
Percutaneous Pinning ◽  
Pin Fixation ◽  
Significant Difference ◽  
Carrying Angle

BACKGROUND Supracondylar fracture of humerus is a common fracture in children. Closed manipulative reduction and percutaneous K-wire fixation is the most widely recognized treatment method for displaced supracondylar humerus fracture in children but controversy persists regarding the ideal pin fixation technique. The purpose of this study was to compare the radiological and functional outcome of lateral entry pinning with that of crossed pinning fixation for Gartland type III supracondylar humerus fractures in children. METHODS This prospective cohort study was conducted in Govt. Medical College Hospital, Thiruvananthapuram from February, 2015 to September, 2016. A total of 54 patients who satisfied the inclusion and exclusion criteria were enrolled in the study. They were allocated to Group A (crossed pin fixation) and Group B (lateral pin) fixation with 27 patients in each. All the cases of percutaneous pinning were done according to a uniform standardized technique. The patients were reevaluated at post-operative day, three weeks, and three months after the surgery. Following information were recorded as outcome measures: (i) carrying angle (ii) range of motion (iii) modified Flynn’s criteria. (v) Baumann’s angle (vi) neurovascular injury. RESULTS There was no statistically significant difference between crossed and lateral pinning with regard to mean Baumann's angle, carrying angle, complication rate, stability and functional outcome, but there was evidence of iatrogenic ulnar nerve injury (3.7 %) in crossed pinning group. There was one case of pin tract infection. CONCLUSIONS There is no statistically significant difference between the radiological and functional outcome provided by crossed pin fixation method and lateral pin fixation methods. Closed reduction and percutaneous pin fixation are safe and efficient methods for fixation of displaced supracondylar fractures of the humerus. Closed reduction and percutaneous pin fixation for displaced supracondylar factures of the humerus in children gives good functional and cosmetic results. KEYWORDS Humerus, Percutaneous Pinning, Supracondylar Fracture

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals 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

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.

scholarly journals SUPRACONDYLAR FRACTURE OF HUMERUS;

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.

scholarly journals Surgical Management of Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning with Kirschnner Wires-A Cross-sectional Study

2021 ◽  
Author(s):  
Chavan Pramod Babu ◽  
K Shankara ◽  
T Lakshmeesha
Keyword(s):  
Closed Reduction ◽  
Statistical Tests ◽  
Excellent Result ◽  
Cross Sectional Study ◽  
Supracondylar Fracture ◽  
Percutaneous Pinning ◽  
Sectional Study ◽  
Supracondylar Fractures ◽  
Cross Sectional ◽  
Type Iii

Introduction: Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. Aim: To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. Materials and Methods: This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus K-wire followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analyzed as per appropriate descriptive statistical tests. Results: The mean age of the patients was 7.4 years (range 3-15years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.6%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K- wire pinning and 17 of them with crossed K-wire pinning configuration. The commonest post-operative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. Conclusion: The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications.

scholarly journals Application of ultrasound in the closed reduction and percutaneous pinning in supracondylar humeral fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yang Wu ◽  
Rongbin Lu ◽  
Shijie Liao ◽  
Xiaofei Ding ◽  
Wei Su ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Closed Reduction ◽  
Humeral Fractures ◽  
Elbow Fracture ◽  
Percutaneous Pinning ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Supracondylar Humeral Fractures ◽  
The Mean ◽  
Ultrasound Group

Abstract Background Ultrasound examination can be applied to the diagnosis of pediatric elbow fracture. This study aims to analyze the application value of ultrasound in the surgical treatment of supracondylar humeral fractures. Methods 64 children with supracondylar humeral fractures were treated with ultrasound-guided closed reduction and percutaneous pinning (CRPP), 31 patients were treated with CRPP under radiography guidence. The reduction effect of supracondylar humeral fractures was determined through the perioperative ultrasound images of the lateral, medial and posterior aspects of the elbow. Percutaneous pinning was performed after supracondylar humeral fractures were well reduced. A follow-up examination was performed and all the patients were evaluated according to Flynn’s criteria. Results The mean duration of surgery was 58.3 min (42–108 min) in the ultrasound group and 41.5 min (24-63 min) in the radiography group (P < 0.05). The mean carrying angle was 8.2° (0°–15°) in the ultrasound group and 9.4°(3°–16°) in the radiography group; The mean Baumann’s angle was 75.5°(60°–85°) in the ultrasound group and 73.4°(62°–82°) in the radiography group; The mean lateral humerocapitellar angle was 38.4° (26°–54°) in the ultrasound group and 41.6°(29°–52°) in the radiography group; No significant differences were observed between the two groups. According to the Flynn’s criteria, 49 (76.6%) patients had excellent, 10 (15.6%) patients achieved good, 3 (4.7%) patients showed fair results and 2 (3.1%) patients achieved poor results in the ultrasound group; 22 (70.9%) patients had excellent, 6 (19.4%) patients achieved good, 2 (6.5%) patients showed fair results and 1 (3.2%) patients achieved poor results in the radiography group; No statistically significant difference was noted between the results of these two groups (P > 0.05). After surgery, three patients had pin tract infection. One patient had ulnar nerve neurapraxia in the radiography group. No cases with Volkmann’s contracture were reported. Conclusion Ultrasound-guided CRPP is a safe and reliable surgical treatment of pediatric supracondylar humeral fractures. Trial registration Retrospectively registered.

scholarly journals Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Li-wei Xie ◽  
Juan Wang ◽  
Zhi-qiang Deng
Keyword(s):  
Brachial Artery ◽  
Closed Reduction ◽  
Duplex Ultrasound ◽  
Humeral Fractures ◽  
Percutaneous Pinning ◽  
Radial Pulse ◽  
Color Flow ◽  
Surgical Exploration ◽  
Close Observation ◽  
Supracondylar Humeral Fractures

Abstract Background The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. Methods Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function. Conclusions Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

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