Is Percutaneous Fixation Necessary & Adequate For Displaced Supracondylar Fractures of Humerus in Children? - An
Institutional Study

Supracondylar humerus fracture (SCHF) is frequently encountered in pediatric age group and 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 stabilization with percutaneous pins. Aim: This retrospective study was conducted to find out the outcome and safety of percutaneous pinning techniques which includes lateral pinning and cross pinning in terms of functional and radiological outcome in the management of displaced supracondylar humerus fractures in children and to see the associated complications with this method of fixation. Materials & Methods: This retrospective study comprising of 40 cases of displaced supracondylar humerus fracture, treated with lateral or cross pinning was carried out at Orthopedics Department, Gujarat Adani Institute of Medical Sciences and G.K General Hospital, Bhuj from July 2019 to june2020. The inclusion criteria were: a) Gartland extension type II, III, b) age below 12 years, c) presented to OPD/Emergency within 48 hours of injury, d) closed and gustilo grade I open fractures, Patients with: a) extension Type I of fractures, b) flexion type injuries, c) except Gustilo grade 1 open fracture d) age more than 12 year e) pervious history of fractures or nerve injury around the elbow, were excluded from the study. Results: Out of the 40 patients, 25 (62.5%) were male and 15(37.5%) were female. The children were aged 2 years to 12 years with a median age of 7.67 years. There were 19 left sided and 21 right-sided fractures. 29 children had an injury while playing and 11 had a fall from a height. functional results in our study were 67.5% of cases had excellent results, 25% had good results, 5% had a fair result and 2.5% had a poor result. 75% of cases had excellent cosmetic results were 17.5% of cases had good results, 5% had fair result and only one case had a poor result. Conclusion: In our study, we found that anatomical reduction and intra- operative stability will dictate the type of configuration to be used in SCHF

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A Rare Case of Pseudoaneurysm of the Brachial Artery in Supracondylar Humerus Fracture

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2256 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Shrihari L Kulkarni ◽

Manjunath S Daragad ◽

Sunil Mannual ◽

Yashwanth Krishna

Keyword(s):

Brachial Artery ◽

Rare Case ◽

Saphenous Vein Graft ◽

Vascular Complications ◽

Humerus Fracture ◽

Type I ◽

Supracondylar Humerus Fracture ◽

Fractures In Children ◽

Pulsatile Mass ◽

Supracondylar Humerus Fractures

Introduction: Supracondylar humerus fractures are very common fractures in children. About 10–14% are associated with vascular complications. We report a rare case of pseudoaneurysm of the brachial artery which was promptly detected in a well-perfused hand nearly 2 weeks after reduction and fixation. Case Report: A 10-year-old girl with Type I open supracondylar fracture of the left humerus (Modified Gartland Type 2) presented 2 weeks post-fixation with pulsatile mass in the elbow. Imaging revealed a pseudoaneurysm of brachial artery which was managed by excision and reconstruction using great saphenous vein graft. The fracture united uneventfully and the child made a full return to pre-fracture level of activity. Conclusion: The case highlights the occurrence of pseudoaneurysm of brachial artery, a rare complication seen few days or weeks after the injury, which coincides with the post-operative period in children managed by surgical fixation. This emphasizes the need for periodic monitoring of the neurovascular status of the children even after successful reduction and fixation. Keywords: Supracondylar humerus fracture, vascular complication, pseudoaneurysm.

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

10.21203/rs.3.rs-15966/v1 ◽

2020 ◽

Author(s):

Allieu Kamara ◽

Xianglu Ji ◽

Chuang Liu ◽

Tianjing Liu ◽

Enbo Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Preoperative Evaluation ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Element Analysis ◽

Bone Model ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Flexion Extension

Abstract Background : This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of crossed and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Method : Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed computationally. Various crossed and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results : Two-crossed pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-crossed pins were the most stable in all loading directions. The crossed pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-crossed pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion : In the fixation of extension-type, transverse supracondylar humerus fractures, 2-crossed pins are only superior to 2-divergent lateral pins in rotational loadings. Two-crossed pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-crossed pins however offer the best stability against both compression and rotation forces.This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194830 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1202

Author(s):

Mohamad Gouse ◽

Manoharan Muthulingam ◽

Nandakumar Rangarajan

Keyword(s):

Functional Outcome ◽

Closed Reduction ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Early Mobilization ◽

Functional Results ◽

Type Ii ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Supracondylar Humerus Fractures

Background: Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.Methods: 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).Results: In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.Conclusions: From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness.

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The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

10.21203/rs.3.rs-15966/v2 ◽

2020 ◽

Author(s):

Allieu Kamara ◽

Xianglu Ji ◽

Chuang Liu ◽

Tianjing Liu ◽

Enbo Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Three Dimensional ◽

Humerus Fracture ◽

Supracondylar Humerus Fracture ◽

Element Analysis ◽

Bone Model ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Flexion Extension

Abstract Background: This study aimed at finding out the effect of exit height of pins, pin trajectory and pin number on the stability of cross and lateral pinning configurations used in the fixation of extension-type supracondylar humerus fracture (SHF) in children, through finite element analysis of a novel pediatric humerus bone model. Methods: Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and lateral pinning fixation models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions. Results: Two-cross pins and 2-lateral pins were respectively more stable in rotation and compression loadings, while 3-cross pins were the most stable in all loading directions. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a mid-ONC distal pin provided the best stiffness among the 2-lateral pins. A third pin however, going through the olecranon fossa led to improved stability of the 2-lateral pins in flexion, extension, internal and external rotations. Conclusion: In the fixation of extension-type, transverse supracondylar humerus fractures, 2-cross pins are only superior to 2-divergent lateral pins in rotational loadings. Two-cross pins exiting at the upper border of the MDJ provides the best stability, whereas 2-lateral pins with a distal pin going through the middle third of the ONC provides the best stability against compression forces for these fractures. Three-cross pins however offer the best stability against both compression and rotation forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

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Comparison of Outcome of Three Different Approaches for Supracondylar Humerus Fractures in Children

10.53350/pjmhs2115103482 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3482-3484

Author(s):

Syed Usman Shah ◽

Mohammad Younas ◽

Naseer Ullah Khattak ◽

Amina Gul Shehzar Khan ◽

Sultan Shah ◽

...

Keyword(s):

Posterior Approach ◽

Lateral Approach ◽

Supracondylar Fractures ◽

Medial Approach ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Significant Difference ◽

Group A ◽

Humerus Fractures ◽

Group B

Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction

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Therapeutically effect of the physical procedures on the elbow contractures in children with supracondylar humerus fractures

Acta chirurgica iugoslavica ◽

10.2298/aci0702039j ◽

2007 ◽

Vol 54 (2) ◽

pp. 39-43 ◽

Cited By ~ 1

Author(s):

S.Dj. Jandric

Keyword(s):

Physical Therapy ◽

Range Of Motion ◽

Elbow Joint ◽

Pediatric Population ◽

Excellent Result ◽

Supracondylar Fractures ◽

Functional Disturbance ◽

Fractures In Children ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

Supracondylar humerus fractures are the most common fracture around the elbow in the pediatric population. These fractures in children may lead to functional disturbance with loss or reduction of range of motion in the elbow joint. The aim of this study was to investigate the effect of the physical therapy on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood after supracondylar fractures. We analyzed in this research 34 children (average age 8.57+2.94 years) with elbow contractures that were treated by physical therapy after orthopedic treatment. Functional outcome was presented in degree from 1 to 3 (Flynn). The difference in the grade at the beginning and the end of the therapy is statistically significant (t=16.38, p<0.001). 91.18 %, of the children had excellent result. Complex of various therapeutically physical procedures can significant improve range of motion of the elbow joint. .

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Does the timing of surgery affect outcomes of gartland type III supracondylar fractures in children?

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7225-32 ◽

2019 ◽

Vol 7 (2) ◽

pp. 25-32

Author(s):

Hyun-Chul Shon ◽

Ji Wan Kim ◽

Hun-Kyu Shin ◽

Eugene Kim ◽

Se-Jin Park ◽

...

Keyword(s):

Range Of Motion ◽

Clinical Outcomes ◽

Operation Time ◽

Timing Of Surgery ◽

Bone Union ◽

Supracondylar Fractures ◽

Type Iii ◽

Fractures In Children ◽

Pin Fixation ◽

Supracondylar Humerus Fractures

Background. Gartland type III supracondylar fractures in children are treated as emergency. But there are few studies about surgical timing and clinical outcomes. Aim. To evaluate whether the time interval from injury to surgical treatment affects the treatment outcomes of Gartland type III supracondylar fractures in children. Methods. The study population comprised all children presenting to our hospital between April 2003 and December 2013, who had Gartland type III supracondylar humerus fracture. Patients were divided into three groups: those who were treated within less than six hours from injury, those who were treated between six and twelve hours, and those who were treated between twelve and twenty four hours after injury. In this retrospective study, we checked whether the timing of surgery affected clinical outcomes such as bone union, range of motion, peri-operative complications, and operation time. Results. All patients were treated with closed reduction and percutaneous pin fixation within 24 hours. This study showed a trend that the delay in the timing of surgery after traumatic injury increases operation time, however with no statistical differences. The neurological complications were similar in the three groups. There were 11 cases (14.7%) of preoperative neurologic deficit, however every patient recovered postoperatively. There was no difference between the three groups in terms of clinical outcomes such as range of motion of the elbow and bone union. Conclusion. For Gartland III pediatric supracondylar humerus fractures, operation can be delayed for up to 24 hours, which may allow time for operation during regular hours, rather than late at night, with thorough evaluation of circulation, nerve injury, and swelling.

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Open Reduction of Supracondylar Humerus Fractures in Children for Failed Closed Reduction: Outcome of Delayed Treatment

Majalah Kedokteran Bandung ◽

10.15395/mkb.v53n3.2127 ◽

2021 ◽

Vol 53 (3) ◽

pp. 143-147

Author(s):

Yoyos Dias Ismiarto ◽

◽

Mahyudin ◽

Adriel Benedict Haryono

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Kirschner Wire ◽

Early Group ◽

Supracondylar Fractures ◽

Delayed Treatment ◽

Type Iii ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures

Supracondylar fractures of the humerus are common in children and the advocated treatments for these fractures include closed reduction and percutaneous pinning. There are numerous debates on the intervention period selection for delayed treatment in children. This phenomenon is prevalent in regions with limited healthcare support. The objective of this study was to compare the outcome of early and late treatment groups, including preliminary presentations and the management of failed treatment. This was a prospective comparative study on early and late open reduction, featuring Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 18 years. Patients from January 2018 to January 2019 were categorized into early and late groups (n=22 and n=26), consisting of 33 (86.8%) males and 15 (31.25%) females. Flynn’s criteria were used to evaluate them. The average time from injury to surgery was 50.24±23.5 hours in the early group and 373.79±89.23 hours in the late group (p<0.002). While the Bauman’s angle recorded after 12 weeks presented the values of 82.04 ± 5.18 and 77.38±6.43 (p=0.622) for the early and late groups, respectively. Pre-operative nerve injuries were observed only in 4 (8.33%) cases from the early group. The functional outcomes of both categories were not significantly different statistically (p=0.242). The outcome for children with supracondylar humerus fracture Gartland type III was satisfactory in both groups. In conclusion, treatment delay does not result in a difference in the outcome according to Flynn's criteria.

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Pediatric brachial artery injury due to supracondylar humerus fractures: A case series

Vascular ◽

10.1177/1708538119851664 ◽

2019 ◽

Vol 27 (4) ◽

pp. 451-453 ◽

Cited By ~ 1

Author(s):

Courtney Grant ◽

Mark Theiss ◽

Dipankar Mukherjee

Keyword(s):

Brachial Artery ◽

Case Series ◽

Duplex Ultrasound ◽

Humerus Fracture ◽

Close Monitoring ◽

Supracondylar Humerus Fracture ◽

Surgical Exploration ◽

Artery Injury ◽

Supracondylar Humerus Fractures ◽

Humerus Fractures

Objectives Two to 20% of pediatric supracondylar humerus fractures present with abnormal vascular examinations ranging from ischemic hands to perfused pulseless hands. Management of perfused pulseless hands with observation or surgical exploration remains debatable. We report management and outcomes of five cases at our institution. Methods Charts of patients <18 years old with supracondylar humerus fractures undergoing brachial artery exploration from 2009 to 2016 were reviewed. Results Five patients presented with supracondylar humerus fracture after falls. Closed reduction and percutaneous pinning resulted in five pink hands, one with a palpable pulse and one with return of radial Doppler signal. Two were admitted for observation and one underwent immediate brachial artery exploration. The four cases initially managed non-operatively underwent exploration. Intraoperative findings included three brachial artery entrapments, one arterial compression due to hematoma, and one complete arterial transection requiring thrombectomy and venous interposition graft. At follow-up, all patients had palpable radial pulses. Conclusions Perfused pulseless hands after supracondylar humerus fracture reduction require close monitoring. Cases without return of radial Doppler signals should undergo immediate brachial exploration. We recommend duplex ultrasound for the diagnosis of brachial artery injury as an early guide to surgical exploration to prevent treatment delay and arm or hand ischemia.

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Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues

Scandinavian Journal of Surgery ◽

10.1177/1457496920908770 ◽

2020 ◽

pp. 145749692090877

Author(s):

J. Hannonen ◽

T. Pokka ◽

W. Serlo ◽

J.-J. Sinikumpu

Keyword(s):

Surgical Technique ◽

Confidence Interval ◽

Kirschner Wire ◽

Surgical Techniques ◽

Humerus Fracture ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Entry Points ◽

Type 3

Background and Aims: Lateral-only Kirschner-wire pinning of supracondylar humerus fracture is superior in avoiding surgery-related ulnar nerve injury. Their disadvantageous effects on stability may be a consequence of inappropriate surgical techniques. We analyzed whether the surgeon’s preference for lateral-only fixation is associated with his or her orthopedic competence. We also analyzed the surgical technique–related risk factors of redisplacement. Materials and Methods: All children, aged <16 years, with a distal humerus fracture in 2000–2009 were preliminary included (N = 861). Altogether, 24 of the 165 type-3 supracondylar fractures were operated by lateral-only pinning. Loss of reduction in the follow-up was the main outcome, while the close characteristics of the surgical technique and treating surgeon’s orthopedic competence were the explanatory variables. Results: Orthopedic surgeons used lateral-only method in 23.5% of the type-3 fractures (N = 16/68), and other surgeons in 8.2% (N = 8/97)(difference = 15.3%, 95% confidence interval = 4.6%–27.6%, p = 0.005). One-third of the lateral-only treated fractures (29.2%, 95% confidence interval = 12.6%–51.1%) redisplaced. Lateral-entry pins that crossed at the level of the fracture were associated with failure (87.5%), while no patient with appropriate pin configuration failed (difference = 87.5%, 95% confidence interval = 52.1%–97.8%). A shorter distance (<5 mm) between the entry points of the pins was associated with redisplacement (80% vs. 15.8%, difference = 64.2%, 95% confidence interval = 16.1%–86.9%). Open reduction (p = 0.07), insufficient (<4 mm) bone contact (p = 0.28), monocortical pins (p = 0.569), low diverging angle (p = 0.13) or parallel pins (p = 1.0), residual coronal displacement (p = 1.0), >5° changed Bauman angle (p = 0.11), rotational displacement (p = 0.25), and the experience or specialty of the surgeon were not associated with redisplacement. Conclusion: Lateral-only pins resulted in poor stability in one in three of the patients. Appropriate configuration of the pins was associated with good fracture healing, but crossing the pins at the fracture level and introducing them close to each other were associated with redisplacement. Surgeons with more orthopedic competence selected lateral-only fixation more usually.

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