Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

Background. Supracondylar fractures are the commonest elbow injury in children. Most displaced supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. This clinical study has results purely from a three lateral divergent wire technique. Methods. Displaced supracondylar fractures were manipulated closed and three lateral divergent wires inserted. Primary study end points were range of movement and carrying angle relative to the contralateral uninjured elbow (Flynn's grading system) and presence of iatrogenic nerve or vessel injury. Results. 25 children between 3 and 10 years (median 5, range 3–10) suffered a displaced fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21 in the first 24 hours. 2 were delayed due to swelling. 2 were fixed secondarily with lateral k-wires after loss of position (from a primarily fixed crossed wire technique). One radial and one median nerve palsy sustained at injury settled. No iatrogenic nerve injuries occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading. Conclusions. The use of three wires on the lateral side in this cohort showed no evidence of slip in fracture position and no iatrogenic nerve injury.

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Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22034 ◽

2019 ◽

Vol 10 (2) ◽

pp. 58-61

Author(s):

Krishna Sapkota ◽

Krishna Wahegaonkar ◽

Niraj Ranjeet ◽

Pabin Thapa ◽

Upendra Jung Thapa ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Distal Humerus ◽

Supracondylar Fracture ◽

Good Stability ◽

Lateral Side ◽

Supracondylar Fractures ◽

Wire Fixation ◽

Ulnar Nerve Injury ◽

K Wires

Background: Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability. Materials and Methods: This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture. Result: Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups. Conclusion: Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

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Radiation Exposure in The Treatment of Pediatric Supracondylar Humerus Fractures: Comparison of Two Fixation Methods

The Open Orthopaedics Journal ◽

10.2174/1874325002115010022 ◽

2021 ◽

Vol 15 (1) ◽

pp. 22-26

Author(s):

Themistoklis Tzatzairis ◽

Gregory Firth ◽

Paulien Bijlsma ◽

Dimitrios Manoukian ◽

Claudia Maizen ◽

...

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Trauma Centre ◽

Fixation Method ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Major Trauma Centre ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

K Wires

Aim: The study aims to determine the estimated radiation exposure of two different types of fixation (crossed vs lateral-entry K-wires) for displaced supracondylar fractures at a Major Trauma Centre in London. Methods: A retrospective review was performed between 2015 and 2019 in children (<16 years old) who underwent either Closed Reduction and Percutaneous Pinning (CRPP) or open reduction and K wire fixation for a displaced supracondylar fracture (Gartland II, III and IV) of the humerus. Results: The overall mean radiation dose and duration with crossed K-wire fixation was statistically lower when compared with two lateral K-wires. The mean radiation dose increased with increasing Gartland Grade - for Gartland Grades II, III and IV respectively. Conclusion: The current study showed statistically significant decreased radiation dose in crossed K-wire fixation method, compared to lateral-entry fixation. No difference was found regarding the cosmetic/functional outcome when Flynn’s criteria were applied.

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Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190536 ◽

2019 ◽

Vol 7 (3) ◽

pp. 717

Author(s):

Ramesh Chand Jindal ◽

Manjeet Singh ◽

H. S. Sandhu ◽

Gurwinder Singh Bal ◽

Harish V. K. Ratna ◽

...

Keyword(s):

Supracondylar Fracture ◽

Supracondylar Fractures ◽

Articular Fracture ◽

Lateral Entry ◽

Group A ◽

K Wires ◽

Fracture Humerus ◽

Immature Skeleton ◽

Vertical Wire ◽

Flexion And Extension

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture and rapid inclusion of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.

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Evaluation of Gartland Type-III Closed Supracondylar Fracture of Humerus in Children Treated by Lateral Percutaneous K-Wires under C-Arm Guidance

Medicine Today ◽

10.3329/medtoday.v33i2.56060 ◽

2021 ◽

Vol 33 (2) ◽

pp. 138-142

Author(s):

Md Insanul Alam ◽

Sheikh Firoj Kabir ◽

Md Faridul Islam ◽

Md Ismail Hossain ◽

Md Omar Faruque ◽

...

Keyword(s):

Closed Reduction ◽

Elbow Flexion ◽

Supracondylar Fracture ◽

Type Iii ◽

Median Nerve Palsy ◽

Pin Fixation ◽

Number Of Patients ◽

Quasi Experimental ◽

Carrying Angle ◽

K Wires

Introduction: This study has been designed to evaluate the success rate of closed reduction and stabilization by two lateral parallel percutaneous K-wires with the help of C-arm in the management of Gartland type-III closed supracondylar fracture of humerus in children. Materials and Methods: A prospective quasi experimental study was conducted from January 2015 to December 2016 in NITOR. A total of 30 patients of Gartland type-III closed supracondylar fracture of humerus in children presenting between ages 3-12 years. Informed written consent was taken from patient’s guardian. Regular follow up was targeted for at least 6 month’s. Result was evaluated according to Flynn’s grading. Results: Mean age was 6.85± 2.37 years, number of patients ware 30, Male patients were more affected 22 (73.33%) than female 8(26.67%), left side patients were more affected. Mean loss of elbow flexion was 9.53 degrees, mean loss of carrying angle was 8.5 degrees. Complications included four (13.33%) cases of pin tract infection, four (13.33%) cases of fracture blister, one (3.33%) case of median nerve palsy, two (6.66%) cases of inadequate pin fixation at first attempt. There were six excellent (20%), eighteen good (60%), three (10%) fair and three (10%) poor results according to Flynn’s grading. The overall 90% satisfactory result and rest 10% unsatisfactory result. Conclusion: Closed reduction and stabilization by two lateral parallel percutaneous K-wires is a better method for treatment of Gartland type-III closed supracondylar fracture in children. Medicine Today 2021 Vol.33(2): 138-142

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Results of a Conservative Management of Minimally Displaced Lateral Condyle of Humerus Fracture in Children

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v12i1.13398 ◽

2015 ◽

Vol 12 (1) ◽

pp. 10-13

Author(s):

DK Shrestha ◽

P Bastola ◽

B Dhungel ◽

VP Lakhanpal

Keyword(s):

Range Of Motion ◽

Operative Treatment ◽

Full Range ◽

Humerus Fracture ◽

Lateral Side ◽

Lateral Condyle ◽

Elbow Injury ◽

Medical College ◽

Carrying Angle ◽

Condyle Fracture

Background: Fracture of lateral condyle humerus in pediatric population is second most common elbow injury. There is controversy regarding treatment of minimally displaced (less than 2mm) fracture. If this group can be taken care with non operative treatment it will be an easier and lot cheaper option especially for rural parts of west Nepal.Aim: To see the viability of treatment of minimally displaced lateral condyle humerus fracture with non operative treatment and look for short and immediate results.Methodology: This was a prospective observational, hospital based study carried out in Nepalgunj Medical College teaching Hospital from Jan. 2013 - Jan. 2014. In children between 2.5 - 13 years, with minimally displaced fracture of lateral condyle humerus were radiologically followed up for 12 weeks. All patients underwent long arm cast and serial radiographs in follow ups. At 12 weeks; range of motion, tenderness and carrying angle were looked for.Results: There were 12 patients in the study with average age of 6.95 years, range (SD 2.92). There were no displacements in follow ups. At 6 weeks all had full range of motion and at 12 weeks all had full range of motion without tenderness. Three kids had approximately 5 degrees of carrying angle change on other side to varus.Conclusion: Non operative treatment with 4 weeks of long arm cast in supination is a good alternative option for minimally displaced lateral condyle fracture humerus. A good follow up of the treated patients is an integral part of management along with radiological evidence. Parents need to be warned about bump in the lateral side during healing.Journal of Nepalgunj Medical College Vol.12(1) 2014: 10-13

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Medio-lateral entry pin versus lateral entry pin for displaced pediatric supracondylar fractures: A comparative, prospective study

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v11i4.14322 ◽

2016 ◽

Vol 11 (4) ◽

pp. 28-31

Author(s):

Manoj Kandel ◽

Hemant Kumar Gupta ◽

Rajkumar Ravi Hamal ◽

Amit Ranjan Mishra ◽

Rahul Shrestha ◽

...

Keyword(s):

Range Of Motion ◽

Ulnar Nerve ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Fractures In Children ◽

Lateral Group ◽

Significant Difference ◽

The Mean ◽

Carrying Angle ◽

Group B

Background & Objectives: Supracondylar fracture is one of the commonest fractures in children. Although the technique of pinning is controversial, percutaneous medio-lateral entry pinning is theoretically considered more stable biomechanical construct. The drawback of this method is injury to ulnar nerve which is not encountered in only lateral entry pinning.Materials & Methods: This was a prospective, comparative and observational study done in 60 patients which was alternately divided into two groups. The first group (A) underwent medio-lateral entry pinning and the second group (B) underwent lateral entry pinning. They were followed for 24 weeks and the outcome was assessed using Flynn’s criteria.Results: At twenty-four weeks, the mean loss of range of motion of elbow in medio-lateral pinning group was 3.70 degrees (SD±1.93) and that in lateral pinning group was 4.23 degrees (SD ±1.38). The mean loss in carrying angle at twenty-four weeks in medio-lateral group was 2.93 degrees (SD±2.19) and that in lateral group was 4.17 (SD±2.24). There were 2 (6.67%) cases of iatrogenic ulnar nerve injury in medio-lateral pinning group. Out of thirty patients, in medio-lateral pinning group, 25 had excellent results, 5 had good results and none had fair or poor results. While out of 30 patients in lateral pinning group, 23 had excellent results, 7 had good results and none had fair or poor results.Conclusion: There is no significant difference in outcome in terms of loss of carrying angle and range of motion between the medio-lateral pinning group and the lateral pinning group at the end of 6 months.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 28-31

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DISPLACED SUPRACONDYLAR HUMERAL FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1507 ◽

2013 ◽

Vol 20 (05) ◽

pp. 818-824

Author(s):

ZAKIR ALI SHAH, ◽

UZMA ARIF

Keyword(s):

Range Of Motion ◽

Controlled Trial ◽

Supracondylar Fractures ◽

Lateral Entry ◽

Loss Of Reduction ◽

Wire Fixation ◽

Supracondylar Humeral Fractures ◽

Group A ◽

K Wires ◽

Group B

Objective: To compare outcome of patients with supracondylar fractures of humerus treated by cross k wires and lateralentry k wires in children. Study Design: Randomized controlled trial study. Place and duration of study: January 2012 to December2012 at Department of Orthopedics, Nawaz Sharif Social Security hospital, Lahore. Subjects and Methods: Two hundred patients,meeting the selection criteria were identified. These patients were divided into group A and group B randomly. In group A cross k wirefixation and in group B lateral entry k wire fixation was performed. Loss of reduction was assessed and recorded in the immediatepostoperative period and three weeks later at the time of removal of k wires. Range of motion of the elbow, in the form of excellent outcomewas assessed at the end of 12 weeks postoperatively. Results: A total of 200 patients were included in the study. Loss of reduction wasfound in thirty patients (30%) in group A and in forty one patients (41%) in group B. In group A, seventy two patients (72%) had excellentoutcome while twenty eight patients (28%) did not gain the desired range of motion at elbow. In group B, sixty five patients (65%) hadexcellent outcome while in thirty five patients (35%), the desired range of motion at elbow was not achieved. No neurological injuryoccurred with both configurations. Conclusions: Lateral entry k wire fixation is as effective as cross k wire in the treatment of displacedsupracondyler fracture of humerus in children.

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A clinical study of closed reduction and percutaneous Kirschner wire fixation of displaced supracondylar fractures of humerus in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170787 ◽

2017 ◽

Vol 3 (2) ◽

pp. 282

Author(s):

Mohammad Asimuddin ◽

Raju H. Kulkarni

Keyword(s):

Closed Reduction ◽

Kirschner Wire ◽

Fracture Pattern ◽

Supracondylar Fractures ◽

Female Ratio ◽

Lateral Entry ◽

Kirschner Wire Fixation ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

K Wires

Background: Supracondylar fractures of the humerus are the most common fracture pattern of the elbow in children. Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. The purpose of this study was to evaluate the results of stabilization of these fractures by closed reduction and percutaneous Kirschner wire fixation.Methods: Thirty cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patient was 8.3 years [ranges from 4-14 years]. The male to female ratio was 2:1 and left side was involved in 23 cases whereas 7 had right sided injuries. All fractures were of extension type [Gartland’s type III]. Posteromedial displacement was noted in 22 cases whereas 8 fractures were posterolaterally displaced. In 20 cases, lateral entry wires alone were used whereas in 10 cases one lateral and one medial K-wire were used. K- wires were removed after 3 weeks post-operatively and follow-up was done at 6 weeks,12 weeks, 6 months and 12 months, when they were evaluated according to Flynn’s criteria.Results: Results were graded using Flynn’s criteria. Excellent results were achieved in 18 [60%], good in 6 [20%] fair in 4 [13.3%], while poor results were seen in 2 [6.7%] patients.Conclusions: Closed reduction and percutaneous fixation using Kirschner wires is a safe and efficient method for fixation of displaced supracondylar fractures of the humerus in children.

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Comparison of Outcome of Lateral Pinning Versus Medial and Lateral Cross Pinning in Childhood Supracondylar Fractures of Humerus

10.53350/pjmhs211592873 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2873-2875

Author(s):

Mudassar Nazzar ◽

Muhammad Adeel-Ur- Rehman ◽

Rizwan Anwar ◽

Omer Farooq Tanveer ◽

Muhammad Abdul Hanan ◽

...

Keyword(s):

Nerve Injury ◽

Ulnar Nerve ◽

Functional Outcomes ◽

P Value ◽

Supracondylar Fractures ◽

Group I ◽

Pin Fixation ◽

Group Ii ◽

Carrying Angle ◽

Ulnar Nerve Injury

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

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Modified supracondylar dome osteotomy: our experience in 11 children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172504 ◽

2017 ◽

Vol 3 (4) ◽

pp. 766

Author(s):

Abhinav . ◽

Ajoy Kumar Manav ◽

Arjun Singh

Keyword(s):

Posterior Approach ◽

Plate Fixation ◽

Excellent Result ◽

Older Children ◽

Supracondylar Fractures ◽

Loss Of Correction ◽

Dome Osteotomy ◽

K Wires ◽

The Stability ◽

Supracondylar Dome Osteotomy

Background: The present retrospective study was done with 11 children having cubitus varus following supracondylar fractures to access the stability of modified domeosteotomy and its fixation with k-wires in older children.Methods: 11 children, 7 males & 4 females were included in the study. The osteotomy was performed through posterior approach. The triangular wedge rotated inside the notch was inherently stable and also fixed with k-wires. Patients were followed at regular intervals. K wires were removed at 6 weeks and the physiotherapy started.Results: The correction obtained under vision was well maintained post operatively in 10 out of 11 cases. In only one case there was back out of k-wires and loss of correction. 5 cases had excellent result followed by 4 good and one fair result. Conclusions: Modified dome osteotomy performed through posterior approach and fixed with k-wires gives good results. Removal of the k-wires is simple. However, in children above 14 years plate fixation might be better to prevent loss of correction.

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