Case Report: Locking Plate for Cubitus Varus Correction in a 7-Year-Old Girl With Osteogenesis Imperfecta

Background: Cubitus varus deformity is a common complication of untreated elbow fractures in children. However, cubitus varus in osteogenesis imperfecta (OI) children is a rare but challenging situation. To the author's knowledge, this is the first study discussing the correction of cubitus varus deformity in patient with OI.Case Presentation: Here we report a case of a 7-year-old OI girl with cubitus varus deformity due to a supracondylar fracture of humerus 3 year ago. The patient's parent gave a history of supracondylar fracture of left humerus in 2015. Without medical intervention, the patient was admitted into our institution for corrective surgery with the diagnosis of osteogenesis imperfecta and cubitus varus deformity in the left arm.Result: Medications including calcium, vitamin D and bisphosphonates were administered before the corrective surgery of cubitus varus, and a single locking plate was used to fixate the osteotomy. After the surgery, the appearance and range of motion (ROM) of the left arm was almost normal. Combined with gradual rehabilitation, the ROM of the left arm was normal without pain during daily use within the 1-year follow up. The hardware was removed as the nailing of the forearm fractures was performed at the same time. In the latest follow-up in September 2021, the appearance and ROM of the left arm was normal.Conclusion: Cubitus varus is a common deformity in children with elbow injuries, but it presents a challenging situation in compound fractures in OI patients. Locking plate combined with meticulous pharmacological intervention provides a good option for corrective surgery of cubitus varus in patients with OI.

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

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

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

Profunda Brachii Pseudoaneurysm following Supracondylar Fracture of Humerus Repair in an 8-Year-Old Boy: A Case Report and Review of Literature

Arterial pseudoaneurysm can manifest in almost all arteries, but peripheral ones such as brachial artery pseudoaneurysm are rare and typically happen after trauma or infections. We describe an 8-year-old boy who presented with a large nonpulsatile soft tissue mass-like lesion 20 days after supracondylar fracture of the humerus which was fixed using Kirschner wire. The neurovascular examination was normal; CT angiography revealed a large pseudoaneurysm arising from the left profunda brachii artery. The patient went under surgical repair and was discharged from the hospital with an uneventful postop course. A high index of suspicion is necessary in cases with humeral fractures for the early diagnosis of pseudoaneurysm where the delayed diagnosis may cause fatal outcomes.

Evaluation of Elbow Range of Motion Following Delayed Surgical Fixation of Pediatric Supracondylar Humerus Fractures: A Prospective Study

Introduction: To achieve excellent functional outcome in Pediatric Supracondylar fractures, early surgical fixation is recommended. Unfortunately, there are still some cases which have delayed presentation to the medical health care, leading to delay in appropriate management required for a good functional outcome. We studied the functional outcome, in terms of range of motion following fixation of type III supracondylar fracture of humerus in children presenting 10 days after initial injury. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 44 pediatric patients presenting to the Emergency and outpatient department with initial trauma to affected elbow more than 10 days old with Supracondylar Fracture of Humerus extension type III were admitted and Open Surgical Fixation with K-wires was performed and Half Cast above elbow was applied for 3 weeks. Goniometer was used to measure range of motion of the effected elbow following the removal of half cast on the day of removal of cast, at 1 week, 2 weeks, and then at 2 weekly intervals until 90 % of Range of motion of the contralateral normal elbow was achieved. Results: The mean delay in presentation was 13.20 ± 2.66 days. None of the patients had close manipulation attempted. Mean Hospital stay was 40.20 ± 1.46 hours. It took a mean of 35.25±2.79 and 49.43± 1.21 days to achieve 90% range of motion in extension and flexion (p-value ≤ 0.001). On average extension was achieved earlier than flexion range of motion. Conclusion: Our study showed good functional outcome in terms of elbow flexion and extension in patients managed after delayed presentation of supracondylar humerus fracture but taking longer time to achieve 90% ROM of the normal elbow. Despite delayed presentation being common in our population, it is not associated with increased peri and post-op complications. Because the ROM improves over time, prolonged follow up is all that is required in such patients. Key words: Delayed fixation, Pediatric, Supracondylar Fracture

CONSTRAINED HINGED ELBOW ARTHROPLASTY IN AN BONY ANKYLOSED ELBOW WITH NON UNION SUPRACONDYLAR FRACTURE HUMERUS: A CASE REPORT

Ankylosis of elbow is a very difcult case to treat. Now Total elbow arthroplasty (TEA) in managing ankylosis at elbow has evolved much in the recent times and is also most common surgical procedure used in the management of advanced bony ankylosis , rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and difcult fracture around elbow joint in elderly patients. Ÿ TEA for ankylotic elbows in elderly patients with nonunion supracondylar fracture is a good surgical option to restore adequate function of elbow joint. Total elbow prostheses have progressed over the time and now include the constrained, semiconstrained, and modular Ÿ Other joints in the extremity should be carefully examined, as well as the elbow's mobility and function, in order to construct a complete preand post-operative management plan that considers the upper extremity's whole range of motion.. Ÿ However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Complication rates, reoperation rates, and survivorship of modern prostheses are discussed. Technical pearls and pitfalls are discussed