Approach to supracondylar humerus fractures with neurovascular compromise in children

Aksakal, Murat; Ermutlu, Cenk; Sarısözen, Bartu; Akesen, Burak

doi:10.3944/aott.2013.3012

Cited by 16 publications

(7 citation statements)

References 17 publications

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“…The standard treatment for type III extension supracondylar fractures is closed reduction and percutaneous pin fixation. 4 , 5 , 6 However, there is ongoing debate about the use of crossed or parallel pin configuration for fixation of the fracture after closed reduction. 7 , 8 , 9 , 10…”

Section: Introductionmentioning

confidence: 99%

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Reisoğlu¹,

Kazımoğlu²,

Hanay³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveClosed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures.MethodsTreatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction; 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction.ResultsLateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR.ConclusionMedial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation.Level of evidenceLevel IV, Therapeutic study.

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Section: Introductionmentioning

confidence: 99%

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Reisoğlu¹,

Kazımoğlu²,

Hanay³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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“…The presence of the Pucker sign is associated with soft tissue injury, including median nerve and brachial artery entrapment [25]. Moreover, severe displacement and difficulty in reducing fractures are expected [26]. For this reason, immediately postoperative rotational malreduction was associated with the Pucker sign.…”

Section: Discussionmentioning

confidence: 99%

Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures

Seo,

Kim,

Park

et al. 2024

Medicina

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Background and Objectives: Long-term outcomes of immediately postoperative rotational malreduction in the axial plane after operative treatment of supracondylar humeral fractures (SCHF) are unknown. This study aimed to investigate the long-term clinical outcomes and associated factors for immediately postoperative rotational malreduction of SCHF. Materials and methods: In this retrospective case–control study, 88 patients who underwent surgery for Gratland type III SCHF were enrolled between January 2012 and January 2020. Among them, 49 patients had immediately postoperative malrotational reduction (rotational malreduction group) and 39 patients had no rotational deformity (control group). To evaluate the associated factors for immediately postoperative rotational malreduction, demographic data, fracture patterns, physical examination signs, and preoperative radiological parameters were analyzed. To compare the clinical outcomes, operation time, range of motion of the elbow, time from operation to full range of motion, and Flynn criteria were evaluated. The Oxford elbow score was used to investigate long-term clinical outcomes for patients five years after operation. Results: The mean age was 5.7 ± 2.3 years and mean follow-up period was 15.7 ± 4.0 months. The rotational malreduction group had significantly more patients with oblique fracture pattern (p = 0.031) and Pucker sign (p = 0.016) and showed a significantly longer operative time (p = 0.029) than the control group. Although there was no significant difference in the range of elbow motion and the Flynn criteria, the Kaplan–Meier survival curve showed a longer time to recover the full range of elbow motion in the rotational malreduction group (p = 0.040). There were no significant differences in the long-term clinical outcomes assessed using the Oxford elbow score (p = 0.684). Conclusions: Oblique fracture pattern and Pucker sign may be associated with immediately postoperative rotational malreduction in the axial plane. Although patients with immediately postoperative rotational malreduction showed favorable results of long-term clinical outcomes, they required more weeks to recover the full range of elbow motion.

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“…Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment, in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. [6,7,11,14,15] Basic Treatment Principles According to the Type of the Fracture…”

Section: Goals Of Fracture Treatment In Childrenmentioning

confidence: 99%

Basic principles of fracture treatment in children

Ömeroğlu¹

2018

Eklem Hastalik Cerrahisi

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This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

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Approach to supracondylar humerus fractures with neurovascular compromise in children

Cited by 16 publications

References 17 publications

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures

Basic principles of fracture treatment in children

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