Treatment of Gartlands Type II and Type III Supracondylar Fracture Humerus by Closed Reduction And Percutaneous K-wire Fixation

Background: Treatment of Gartland’s type III supracondylar fracture of humerus in children is one of the most challenging one. Conservative management usually results in deformity. On the other hand open reduction and internal fixation is a more invasive surgical method with a long recovery period. Thus, this study presents cases treated by closed reduction and percutaneous pinning and discussed its anatomical results, functional results and lastly its complications.Methods: Twenty five cases were treated with closed reduction and percutaneous pinning at Pushpagiri Medical College.Results: Out of the 25 patients studied, 24 (96%) had satisfactory results according to Modified Flynn’s criteria and there was only one case of superficial pin tract infection with no cases of cubitus varus deformity.Conclusions: This study presents that closed reduction and percutaneous pinning is a very good modality of treatment of Gartland type III fractures of humerus in children with very few complications.

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Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i2.6280 ◽

2012 ◽

Vol 9 (2) ◽

pp. 11-16 ◽

Cited By ~ 4

Author(s):

D Dhoju ◽

D Shrestha ◽

N Parajuli ◽

G Dhakal ◽

R Shrestha

Keyword(s):

Bone Fracture ◽

Closed Reduction ◽

Supracondylar Fracture ◽

Radius Fracture ◽

Type I ◽

Type Iii ◽

Bone Injury ◽

Wire Fixation ◽

Forearm Bone ◽

Floating Elbow

Background Supracondylar fracture and forearm bone fracture in isolation is common musculoskeletal injury in pediatric age group But combined supracondylar fracture with ipsilateral forearm bone fracture, also known as floating elbow is not common injury. The incidence of this association varies between 3% and 13%. Since the injury is rare and only limited literatures are available, choosing best management options for floating elbow is challenging. Method In retrospective review of 759 consecutive supracondylar fracture managed in between July 2005 to June 2011, children with combined supracondylar fracture with forearm bone injuries were identified and their demographic profiles, mode of injury, fracture types, treatment procedures, outcome and complications were analyzed. Result Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had combined supracondylar fracture and ipsilateral forearm bone injury including four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7 type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion type supracondylar fracture. Nine patients had distal radius fracture, six had distal third both bone fracture, three had distal ulna fracture, two had mid shaft both bone injury and one with segmental ulna with distal radius fracture. There were Monteggia fracture dislocation, proximal ulna fracture, olecranon process fracture, undisplaced radial head fracture of one each and two undisplaced coronoid process fracture. Type I supracondylar fracture with undisplaced forearm were treated with closed reduction and long arm back slab or long arm cast. Displaced forearm fracture required closed reduction and fixation with Kirschner wires or intramedullary nailing. Nineteen patients with Gartland type III fracture underwent operative intervention. Among them nine had closed reduction and K wire fixation for both supracondylar fracture and forearm bone injury. One patient with closed reduction and long arm cast application for both type III supracondylar fracture and distal third radius fracture developed impending compartment syndrome and required splitting of cast, remanipulation and Kirschner wire fixation. There were three radial nerve, one ulnar nerve and one median nerve injury and two postoperative ulnar nerve palsy. Three patients had pin tract related complications. Among type III, 16 (80%) patients had good to excellent, two had fair and one gad poor result in terms of Flynn’s criteria in three months follow up ConclusionDisplaced supracondylar fracture with ipsilateral displaced forearm bone injuries need early operative management in the form of closed reduction and percutaneous pinning which provides not only stable fixation but also allows close observation for early sign and symptom of development of any compartment syndrome.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6280 Kathmandu Univ Med J 2011;9(2):11-16

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Treatment Result Following Fluoroscopic Guided Close Reduction and Internal Fixation by Per-Cutaneous Crossed K-Wires of Extension Type Gartland Type-II and Type-III Supracondylar Fracture of Humerus in Children

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i2.56470 ◽

2021 ◽

Vol 20 (2) ◽

pp. 32-36

Author(s):

Tafhim Ehsan Kabir ◽

ANM Humayun Kabir ◽

Alak Kanti Biswas ◽

Rahma Binte Anwar ◽

Touhidul Islam ◽

...

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Supracondylar Fracture ◽

Treatment Result ◽

Type Ii ◽

Supracondylar Fractures ◽

Female Ratio ◽

Type Iii ◽

K Wires ◽

Tract Infections

Background : Supracondylar fractures of the humerus is one of the most common fractures in children. Failure to treat properly leads to malunion of the fracture site. For that, closed reduction and percutaneous pinning is considered to be the golden choice for treatment. There are many methods in which percutaneous k-wire fixation can be done. The aim of this study is to report the advantages of percutaneous fixation using cross pinning from both medial and lateral sides. Materials and methods : A total number of seventy pediatric patients with Gartland type II and type III supracondylar fracture of the humerus were recruited from the outpatient department of two different hospitals between January 2018 and September 2020. All of them were treated using closed reduction and internal fixation using percutaneous crossed k-wires. The treatment outcomes were evaluated using Flynn’s criteria and were compared with other similar studies. Results : The mean age of study subjects was 8.14 ± 2.8 and the male to female ratio was 1.6:1. In 27(38.6%) cases the left arm was involved while in 43(61.4%) cases the right arm was involved. Preoperative complications included 1(1.4%) case with radial nerve palsy and 4(5.7%) cases with pulseless pink hand. When evaluating cosmetic outcome using Flynn’s criteria, there were 57(81.4%) excellent, 10(14.3%) good and 3(4.3%) fair outcomes. On evaluating outcome according to range of motion deficit outcomes were excellent in 35(50%), good in 22(31.4%), fair in 5(7.2%) and poor in 8(11.4%) children. Post-operative complications were 1(1.4%) ulnar nerve neuropraxia and 5(7.2%) superficial pin tract infections. Conclusion : Closed reduction and internal fixation using percutaneous crossed kwires placed from the medial and lateral side gives satisfactory cosmetic and functional outcomes in majority of the patients with Gartland type II and III supracondylar fractures of the humerus. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 32-36

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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

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i1.22449 ◽

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.

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The Treatment of Mason Type II Radial Head Fractures using Closed Reduction and K-wire Fixation

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2004.17.3.277 ◽

2004 ◽

Vol 17 (3) ◽

pp. 277

Author(s):

Byung Ki Kwon ◽

Song Lee ◽

Dong Ki Ahn ◽

Joon Seong Park ◽

Sang Kyu Cha

Keyword(s):

Radial Head ◽

Closed Reduction ◽

Type Ii ◽

Radial Head Fractures ◽

Wire Fixation

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Functional outcome of displaced supracondylar fracture humerus in children treated by closed reduction and percutaneous pinning with Kirchner wires: An observational study

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i4m.1765 ◽

2019 ◽

Vol 5 (4) ◽

pp. 757-761

Author(s):

Dr. Ashutosh Vikram ◽

Reena .

Keyword(s):

Observational Study ◽

Functional Outcome ◽

Closed Reduction ◽

Supracondylar Fracture ◽

Percutaneous Pinning ◽

Fracture Humerus

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Efficacy and complications after delayed fixation of femoral neck fractures in children

Journal of Orthopaedic Surgery ◽

10.1177/2309499019889682 ◽

2019 ◽

Vol 28 (1) ◽

pp. 230949901988968 ◽

Cited By ~ 2

Author(s):

Chunxing Wu ◽

Bo Ning ◽

Ping Xu ◽

Jun Song ◽

Dahui Wang

Keyword(s):

Femoral Neck ◽

Closed Reduction ◽

Open Reduction ◽

Femoral Neck Fractures ◽

Type I ◽

Type Ii ◽

Type Iii ◽

Fractures In Children ◽

Reduction Group ◽

Time From Injury

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

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Supracondylar (fracture) of humerus in paediatric age group treated with closed reduction versus k-wire fixation

MedPulse International Journal of Orthopedics ◽

10.26611/10201412 ◽

2020 ◽

Vol 14 (1) ◽

pp. 09-14

Author(s):

Ravi Shankar Kumar ◽

◽

Siddhartha Kumar Shrest ◽

Benu Gopal Das ◽

◽

...

Keyword(s):

Closed Reduction ◽

Supracondylar Fracture ◽

Age Group ◽

Wire Fixation ◽

Paediatric Age

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Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

Journal of Wrist Surgery ◽

10.1055/s-0040-1710395 ◽

2020 ◽

Vol 09 (05) ◽

pp. 431-439

Author(s):

Asgeir Amundsen ◽

Sarah N. Bishop ◽

Steven L. Moran

Keyword(s):

Literature Review ◽

Closed Reduction ◽

English Language ◽

Motor Vehicle ◽

Rare Event ◽

Common Mechanism ◽

Type Ii ◽

Vehicle Accidents ◽

Wire Fixation ◽

Ligamentous Reconstruction

Abstract Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

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