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

TO STUDY THE FUNCTIONAL OUTCOME OF BIPLANAR CROSSED PIN K WIRE FIXATION IN DISPLACED SUPRACONDYLAR HUMERUS FRACTURE IN CHILDREN

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 .

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

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.