scholarly journals Short-term Follow-up of Early Reconstructive Surgery Management in Neglected Supracondylar Humeral Fractures

2021 ◽  
Vol 9 (B) ◽  
pp. 24-28
Author(s):  
Tito Sumarwoto ◽  
Seti Aji Hadinoto ◽  
Herlambang Pranandaru ◽  
Hanif Andhika ◽  
Сholahuddin Рhatomy ◽  
...  
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Elbow Fracture ◽  
Performance Score ◽  
Short Term ◽  
Mayo Elbow Performance Score ◽  
Elbow Fractures ◽  
Supracondylar Humeral Fractures ◽  
Early Reconstruction

BACKGROUND: The supracondylar humeral fracture is a fracture located in the proximal position of the trochlea and humeral capitulum. This fracture is the most common elbow fracture in children. Epidemiological research states that these fractures constitute 58% of all elbow fractures in children. It is also mentioned that 10–20% patients undergo belated admission to get therapy. Based on the literature, the fracture is categorized as neglected if the fracture treatment is 14 days post-trauma. Unfortunately, few reports can provide management guidelines. Some experts mention the “wait and see” attitude toward this fracture until a perfect remodeling happens to correct the deformity; however, a number of studies have shown good results after early reconstruction. AIM: We aimed to evaluate the short-term follow-up of supracondylar humeral fractures that came after 14 days of injury and then open reduction reconstructions were done, followed by the installation of K-wire and screws with the figure of eight patterns based on the quick disabilities of the arm, shoulder, and hand (Q-DASH) 9-score, Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS). METHODS: The samples were five patients who underwent corrective open reduction and injury fixed with Kirschner (K)-wire and screws with the figure of eight patterns using the posterior approach at the Orthopedic Hospital from December 2019 to February 2020. Results were assessed with the quick disabilities of the arm, shoulder, and hand-9 score (Q-DASH-9 score), Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS). RESULTS: All patients after reconstruction correction showed an increase in range of motion in the fractured elbow. No complications were found from the surgical treatment. CONCLUSIONS: Early reconstruction correction of patients with supracondylar humeral fractures gave satisfactory results based on the Q-DASH-9 Score, Flynn’s Criteria, and MEPS.

scholarly journals Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

2014 ◽  
Vol 2 (2) ◽  
pp. 31
Author(s):  
Ruban Raj Joshi ◽  
Gabriel David Sundararaj
Keyword(s):  
Internal Fixation ◽  
Operating Room ◽  
Open Reduction ◽  
Stress Test ◽  
Open Reduction Internal Fixation ◽  
Performance Score ◽  
Valgus Stress ◽  
Mayo Elbow Performance Score ◽  
Children And Adolescent

Introduction: Fractures of the medial humeral epicondyle represent approximately 10% of all paediatric elbow fractures. Objective of our study was to assess treatment outcomes of children and adolescent with medial epicondylar fracture of the elbow using standard operative protocols. Methods: 20 surgically treated fractures of the medial humeral epicondyle were analysed & reviewed for their epidemiological, clinical and surgical parameters. A valgus stress test was performed under general anesthesia or sedation. All patients underwent open reduction internal fixation using a similar technique. The medial epicondylar fragment was anatomically reduced and fixed in all cases with screws, Kirshner wires or tension band wiring. At final evaluation, union (radiologically) and elbow function [MAYO elbow performance score (MEPS)] was assessed. Results: An evaluation of all of our patients after a mean follow-up of 8.75 months (SD=4.76) after initial surgery was possible. The mean age of patients at the time of injury was 10.8years (SD=2.3). Fifteen (75%) dominant elbows were injured in our study and 12(60%) elbows had an associated elbow dislocation. On examination in operating room post anaesthesia, all of the elbow injuries revealed some degree of valgus instability. All of our patients(n=20) showed good to excellent results in the MAYO elbow performance score (MEPS). Radiographically, union was achieved in all cases. Three patients developed postoperative ulnar nerve neuropraxia, all recovered at time of final follow up. One patient developed mild lateral heterotrophic ossification but did not require any additional surgical intervention. Conclusion: Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries.

scholarly journals Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

2020 ◽  
Vol 6 (6) ◽  
pp. 1215
Author(s):  
Faisal S. Mohammed ◽  
Akshay B. Ingale
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Distal Humerus Fracture ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Locking Compression Plates ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Extensor Lag

<p><strong>Background:</strong> Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type  13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.</p><p><strong>Methods:</strong> Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.</p><p><strong>Results:</strong> Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.</p><p><strong>Conclusions:</strong> Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.</p>

scholarly journals Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa

2019 ◽  
Vol 19 (3) ◽  
pp. 2565-2570
Author(s):  
Claude Kasereka Masumbuko ◽  
Edward Gakuya Mutheke ◽  
Benjamin Mbindyo ◽  
Michael T Hawkes
Keyword(s):  
Surgical Care ◽  
Elbow Flexion ◽  
Operative Management ◽  
Humeral Fractures ◽  
Sub Saharan Africa ◽  
Delayed Surgery ◽  
Flexion Extension ◽  
Supracondylar Humeral Fractures ◽  
Sub Saharan

Background: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health.Methods: This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab.Results: Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°-118° vs 120° 108°-124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization.Conclusion: In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention.Keywords: Delayed surgery, reduced elbow range, supracondylar humeral fractures, sub-Saharan Africa.

scholarly journals Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children

2014 ◽  
Vol 9 (2) ◽  
pp. 79-88 ◽  
Author(s):  
Ahmet Aslan ◽  
Mehmet Nuri Konya ◽  
Aykut Özdemir ◽  
Hüseyin Yorgancigil ◽  
Gökhan Maralcan ◽  
...  
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Type Iii ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

Temporal characteristics of paediatric supracondylar humerus fractures

Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 208-216
Author(s):  
Bonnie McRae ◽  
Iulian Nusem
Keyword(s):  
Hypothesis Testing ◽  
Supracondylar Fracture ◽  
Fracture Incidence ◽  
Humeral Fractures ◽  
Elbow Injury ◽  
Injury Characteristics ◽  
Supracondylar Humerus Fractures ◽  
Elbow Fractures ◽  
Significant Difference ◽  
Supracondylar Humeral Fractures

Objective Supracondylar humeral fractures are the most common elbow injury occurring in the paediatric population, accounting for 55–80% of all elbow fractures and 3–18% of all paediatric fractures. They occur most commonly due to a fall from play equipment or furniture. This study aims to determine if any relationship exists between supracondylar humeral fractures and any temporal or injury characteristics. It was hypothesised that an increased incidence of supracondylar fractures would be observed in summer months and on weekends. Methods All patients <18 years of age with an isolated distal humerus supracondylar fracture between 2004 and 2014 were included in this study ( n = 569). Patient demographics and fracture characteristic data were collected. Hypothesis testing was performed to assess for any statistically significant relationship between fracture incidence and temporal or injury characteristics. Patients were then divided based on their management (conservative vs. operative) and hypothesis testing was performed to determine whether any difference existed between the management groups with regards to temporal and injury characteristics. Results No statistically significant association was noted between fracture incidence and gender, laterality, or day/month/season of injury. Time of injury and presentation to the Emergency Department demonstrated significant results, with highest incidence in the afternoon hours (12:00–17:59). Conclusions Unlike previous international studies, no significant difference was noted between day/month/season of injury and incidence of supracondylar fracture. This is thought to be likely due to the difference in climate between Australia and other countries.

scholarly journals Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome

2015 ◽  
Vol 135 (7) ◽  
pp. 963-969 ◽  
Author(s):  
Timo Schmid ◽  
Alexander Joeris ◽  
Theddy Slongo ◽  
Sufian S. Ahmad ◽  
Kai Ziebarth
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Supracondylar Humeral Fractures

scholarly journals INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

2021 ◽  
Vol 10 (2) ◽  
pp. 70
Author(s):  
Charlie Sanjaya ◽  
I Ketut Gede Arta Bujangga
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Fracture Site ◽  
Humeral Fractures ◽  
Anatomical Reconstruction ◽  
Type I ◽  
Rigid Fixation ◽  
Distal Humeral Fractures ◽  
Capitellum Fracture

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.

scholarly journals Paediatric supracondylar humeral fractures: the effect of the surgical specialty on the outcomes

2019 ◽  
Vol 13 (1) ◽  
pp. 40-46 ◽  
Author(s):  
A. J. Saarinen ◽  
I. Helenius
Keyword(s):  
Open Reduction ◽  
Humeral Fractures ◽  
Supracondylar Fractures ◽  
Level Of Evidence ◽  
Surgical Specialty ◽  
Orthopaedic Surgeons ◽  
Loss Of Reduction ◽  
Supracondylar Humeral Fractures ◽  
Pin Configuration

PurposeThe effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.MethodsA retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.ResultsResidents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).ConclusionWe found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.Level of evidence:Level III

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