Closed Reduction with and without Percutaneous Pinning in Supracondylar Fractures of the Humerus in Children

Abstract

SA Almohrij, Closed Reduction with and without Percutaneous Pinning in Supracondylar Fractures of the Humerus in Children. 2000; 20(1): 72-74 Supracondylar fractures of the humerus are the most common elbow fractures in children.1,2 These fractures generally occur as a result of a fall on an outstretched hand with hyperextension load on the elbow. The distal fragment displaces backwards, making the extension type by far the most common (95%). Since supracondylar fractures have a peak incidence between 4 to 6 years, it seems there must be something unique about the anatomy of the elbow during this period that facilitates this type of fracture.The three major features that seem to contribute to the unique predisposition of the juvenile supracondylar fracture are ligamentus laxity, the relationship of the joint structure in hyperextension and the bony architecture of the supracondylar area. 3Opinions vary in the literature as to the best treatment of displaced supracondylar fractures. The goals of the treatment are to obtain and maintain an adequate reduction with low incidence of complication, regardless of the mode of treatment. The purpose of this study was to assess early and late results of displaced supracondylar fractures treated by two recognized methods, which are closed reduction (CR) and casting vs. closed reduction and percutaneous pinning (CRPP). Materials and MethodsDuring the period from January 1986 to October 1992, 50 patients with type 3 supracondylar fractures of the humerus (Table 1) were seen in the Emergency Department at King Fahad National Guard Hospital, Riyadh, Saudi Arabia. Thirty-four patients were male, with a mean age of 6 years, and 16 were female, with a mean age of 4 years.The mechanism of injury was fall with hand outstretched in 48 patients, while two patients were involved in road traffic accidents.All patients had extension type supracondylar fractures, 45 with posteromedial displacement and 5 with posterolateral displacement. There were 29 left-sided and 21 right-sided fractures. Follow-up averaged 14 months (6-22 months). Anesthesia time averaged 65 minutes (45-85 minutes). All patients were managed within 12 hours of injury in the operating room under general anesthesia, and 34 patients returned for clinical and radiological examination.The first group of patients (group A) were treated by closed reduction and application of back slab, with elbow flexed more than 90° after accurate reduction was achieved based on standard anterior-posterior (AP) and lateral elbow x-ray, with another radiograph taken one to two days postreduction. The patients were followed weekly in the outpatient clinic and the casts were removed between 5 and 6 weeks.The second group (group B) was treated by closed reduction and percutaneous single medial and lateral pinning with application of back slab of about 60 degrees elbow flexion. The pins were removed in the outpatient clinic between 3 and 4 weeks without any analgesia.The average hospital stay was three days for group A and two days for group B...

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

“…In the present study, 26 (72.22%) were male patients and 10 (27.78%) were female. These findings are in concurrence with other studies [14,15] . Based on Gartland's classification, 16 (44.44%) patients had Type II fracture and 20 (55.56%) had Type III fracture.…”