scholarly journals Intraoperative Kirschner Wire Breakage in a Pediatric Supracondylar Humerus Fracture

Cureus ◽  
2021 ◽  
Author(s):  
Gaurav Ardawatia ◽  
Ankit B Waghela ◽  
Ashish S Ranade
2021 ◽  
pp. 8-11
Author(s):  
Rajesh K. Ambulgekar ◽  
Dhananjay Eknathrao More

BACKGROUND: supracondylar humerus fracture represents most common fracture around elbow in children. This type of fracture usually results due to fall while playing or fall from height on outstretched hand. The treatment of displaced supracondylar fracture of the humerus is one of the most challenging one to prevent complications. METHOD: The study was conducted at department of orthopedics dr. Shankarrao Chavan Government Medical College and Hospital Nanded for treatment of supracondylar humerus fracture .this is a prospective study of 60 cases over period of 18 months ( 2019- 2020 ) RESULT: Extension type fractures were seen in 98.33% of the cases as compared to exion type in 1.66% of the patients.70% had Gartland type III fractures and 30% had type II fractures. 45 had almost full range of motion, 9 had restricted exion ranging from >5 to 10 degrees, 4 children had restriction of exion between 10 to 15 degrees and 2 patients had restricted exion from 15 to 20 degrees. The average restriction of exion was 5.83 degrees. Outcome of patients were graded as per the criteria given by Flynn et al and according to it 46 patients had excellent outcomes, 8 had good results, 4 cases had fair outcomes while only 2 patients had poor results. Out of the 60 patients, 58 (96.66%) had satisfactory outcomes and only 2 (3.33%) had unsatisfactory outcome. CONCLUSION: Percutaneous kirschner wire pinning is a minimally invasive technique that provides a better functional outcome with minimal complications. Hence we concluded that closed reduction and crossed percutaneous pinning is a effective method of treatment .


2020 ◽  
Vol 7 (51) ◽  
pp. 3080-3084
Author(s):  
Chandra Sekhar Rao K ◽  
Shivram Naik V ◽  
Rajesh P

BACKGROUND Supracondylar humerus fracture is the most serious paediatric skeletal injury of elbow in children. Supracondylar fracture of humerus leads to many complications due to the intrinsic fracture instability, close proximity of the brachial artery, three main upper extremity nerves, poor radiographs, contradictory perception of reduction and reduction management modalities and, lastly, patient compliance with care. The aim of this research is to determine the short-term outcomes of closed and open reduction and Kirschner wire fixation in childhood Gartland type III supracondylar humerus fracture. METHODS It is a comparative case series of 2 years duration conducted among 30 patients with supracondylar humerus fracture who were admitted and treated at the Department of Orthopaedics. Closed reduction was handled in 15 out of 30 patients, with the remaining 15 patients being treated by open reduction. The outcomes are calculated on the basis of the Flynn scale, which is based on change in the carrying angle and loss of motion after treatment. RESULTS Males (56.66 %) were more affected than females; left side (66.67 %) was more affected than the right side; fractures of type III were more common. 26 patients stayed in a sufficient range of motion, 4 patients had insufficient motion with a loss of more than 100, of which 3 were treated with a closed reduction and 1 with an open reduction. Twenty-six (86.66 %) of the 30 patients showed good to excellent results and four (13.33 %) showed mediocre to poor results. Of the four cases, one was handled with a closed reduction and three were handled with an open reduction. CONCLUSIONS We conclude that open reduction and K-wire fastening without triceps is a treatment option for displaced supracondylar humerus fractures. KEYWORDS Supracondylar Fracture, Humerus Fracture


Author(s):  
Xianglu Ji ◽  
Allieu Kamara ◽  
Enbo Wang ◽  
Tianjing Liu ◽  
Liwei Shi ◽  
...  

Abstract Background Kirschner wire fixation remains to be the mainstream treatment modality in unstable or displaced supracondylar humerus fracture in children, with divergent lateral pins being the most preferred due to their sufficient stability and decreased risk of ulnar nerve injury. However, the entry point at which the proximal lateral pin can be inserted to achieve a more proximal exit and maximum divergence has not been reported. This study retrospectively analyzed the characteristics and factors influencing the entry and exit points of the proximal lateral pins. Methods The study was divided into two stages. In stage one, the entry and exit points of the proximal pins of lateral pinning configuration were analyzed from intra-operative radiographs of children treated for extension-type supracondylar humerus fractures. The coronal and sagittal pin angles formed by the proximal pins were also measured. Using the findings of stage one, we intentionally tried to achieve a more proximal exit with the proximal pins in stage two. Comparisons between groups of patients treated by random and intentional pinnings were done statistically. Results In the first stage, 47 (29.2%) of the 161 proximal pins exited above the metaphyseal-diaphyseal junction (MDJ) region. Of these, 85.1% entered from lateral and posterior to the ossific nucleus of the capitellum (ONC). The pin angles averaged 58.4° and 90.5° in the coronal and sagittal planes respectively. In the second stage, 47 (65.3%) proximal pins in the intended group exited above the MDJ region, while only 32 (36%) in the random group exited above the MDJ region. Conclusion While aiming at the upper border of the distal MDJ during pinning, lateral pins can easily achieve a higher, proximal exit above the MDJ if inserted from lateral and posterior to the ONC and parallel to the humeral shaft in the sagittal plane. Higher exit can also be easily achieved in younger patients and patients fixated with smaller diameter pins.


2015 ◽  
Vol 2015 (apr29 1) ◽  
pp. bcr2014206313-bcr2014206313 ◽  
Author(s):  
M. Cobanoglu ◽  
S. O. Savk ◽  
E. Cullu ◽  
F. Duygun

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Shrihari L Kulkarni ◽  
Manjunath S Daragad ◽  
Sunil Mannual ◽  
Yashwanth Krishna

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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