RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

Outcome of Retrograde Nailing in the Treatment of Extra Articular Supracondylar Femur Fractures

Objective: To find out outcome of retrograde nailing in the treatment of extra articular supracondylar femur fractures. Study Design: A prospective observational study. Place and Duration of the Study: The Department of Orthopedic Surgery, Ghurki Hospital, Lahore, Pakistan from January 2020 to August 2021. Methodology: A total of 92 patients of both genders aged 18 to 50 years with supracondylar femur fractures and supracondylar fractures with fracture line extending to distal third of femoral shaft were enrolled. Retrograde nailing was performed among all patients. Surgery time and functional outcome were noted. All surgeries were accomplished under spinal/epidural or general anaesthesia. Results: Out of a total of 92 patients, there were 59 (64.1%) were male and 33 (35.9%) female. Overall, the mean age of patients was 33.12±9.08 years. The mean surgery time was noted to be 85.29±7.48 minutes. A total of 85 patients completed the designated period of 12-weeks for the evaluation of functional outcome. Excellent outcomes were observed in 47 (55.3%) cases, good 25 (29.4%), fair 9 (10.6%) and poor in 4 (4.7%) cases. Excellent to good outcomes were observed in 72 (84.7%) cases. Conclusion: Retrograde nailing had good outcomes in the treatment of extra articular supracondylar femur fractures. Keywords: Femur fracture, nailing, surgery time, functional outcome.

Supracondylar fractures of the humerus in children: is departmental documentation hitting national standards?

Background/aims The British Orthopaedic Association's Standards for Trauma for the management of supracondylar humerus fractures in children specify that: ‘A documented assessment of the limb, performed on presentation, must include the status of radial pulse, digital capillary refill time and the individual function of the radial, median (including anterior interosseous) and ulnar nerves.’ Methods The documentation of cases of supracondylar humerus fractures over 1 year was retrospectively analysed. An electronic pro forma for supracondylar humerus fractures was introduced, with prompts for the pieces of documentation required to meet national standards. The use of this pro forma was audited after 6 months and 12 months use. Results Documentation ranged from 10% for anterior interosseous nerve to 53% for radial pulse. In the second reaudit, documentation ranged from 86% for anterior interosseous nerve to 95% for median nerve function. There were 17 patients for whom all documentation was present, and for these patients the pro forma had been used. Use of an electronic clerking pro forma improves adherence. Conclusions Full documentation of neurovascular status in paediatric supracondylar fractures is vital to allow for effective preoperative and postoperative further assessment. With the move into paperless documentation, online pro formas can help clinicians with effective assessment and documentation.

TO EVALUATE THE FUNCTIONAL OUTCOME OF LOCKING COMPRESSION PLATE FOR FRACTURES AROUND KNEE JOINT(DISTAL 1/3RD FEMUR OR PROXIMAL 1/3RD TIBIA)

Background: To evaluate the functional outcome of locking compression plate for fractures around knee joint (Distal 1/3rd femur or proximal 1/3rd tibia) Methods: This prospective functional out-come study has been conducted on This prospective study has been conducted on 50 patients with Distal 1/3rd femur and 50 patients with proximal 1/3rd tibia Results: According to Modified Mehrotra’s Criteria, the excellent (44.00%) and fair (42.00%) and (14.00%) had poor result Conclusion: Locking compression plate is the optimal tool for many supracondylar fractures of femur and proximal tibia fractures. It provides rigid fixation, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult. Keywords: Femur, Tibia, Locking plate, MIPO, Outcome.

Spontaneous humeral torsion deformity correction after displaced supracondylar fractures in children

Background After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time. Methods A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered. Results Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°. Conclusion After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity. Level of Evidence/Clinical relevance Therapeutic Level IV

DIAGNOSTIC TACTICS FOR TRANSCONDYLAR AND SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

Transcondylar and supracondylar fractures of the humerus in children are one of the most relevant and still not completely solved problems of modern pediatric traumatology. In the problem of condylar and supraorbital fractures of the humerus, the issues of diagnosis, choice of indications for surgical revision of the vascular-nervous bundle of the elbow area in this pathology are insufficiently covered. To solve the problems of the study, we analyzed the treatment of 313 victims with transcondylar and supracondylar fractures of the humerus, which were treated at the City Children's Clinical Hospital in Lviv in the period from 2013 to 2018. The structure of the distribution of arrays on the basis of rotational displacement in condylar fractures of the humerus is dominated by displacement up to 30°, which in the first group was found in 61.8% of cases, and in the second group - 69.2% of cases. The share of severe rotational displacements in the structure of group arrays is almost the same in both observation groups: 29.1% in the first group and 29.5% in the second group. Analysis of the proportion of extremely severe rotational displacements up to 90° in the structure of group arrays revealed that such victims were 7 times more among the victims of the first group than among the victims of the second group, due to the use of the proposed unified protocol scheme for diagnosis and treatment humeral fractures in pediatric patients, which avoids or reduces the difference in the occurrence of secondary displacements.

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

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