Completely Displaced Supracondylar Fracture of the Humerus in Children

Kurer, M. H. J.; Regan, Michael W.

doi:10.1097/00003086-199007000-00030

Cited by 55 publications

(46 citation statements)

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“…Its high incidence of unsatisfactory results in 23% of the cases in a multicenter analysis [54] reflects the supracondylar dilemma, which later led to the development of other methods: too much flexion occludes circulation, but too little flexion may allow the fracture to become displaced. The inherent risk of Volkmann's contracture as well as the poor control of the distal fragment with a subsequent high incidence of cubitus varus led to its abandonment [16,54,69,72,73,94] (Figure 6). If closed reduction and plaster immobilization are chosen as a first attempt, the risk of a second procedure is 31% and the risk of an unfavorable outcome is 20% let alone the repeat X-ray controls [41].…”

Section: Complete Displacement (Gartland Iiia B Holmberg III Von Lmentioning

confidence: 99%

Supracondylar Fractures of the Humerus in Children

Hasler

2001

Eur J Trauma

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Closed reduction and percutaneous pinning techniques for displaced supracondylar fractures of the humerus in children (Gartland type III) have overcome disastrous ischemic complications and long inpatient treatment. Closed reduction of those highly unstable fractures and the demanding pin placement itself are potential sources of failure for the inexperienced reflected by the rate of cubitus varus which is still about 5-15% in recent series. Rotational primary and residual displacement has to be appreciated to prevent permanent cosmetic deformity. Malrotation is the major source of instability since bicolumnar support is lost which allows the distal fragment to tilt. Biomechanically tested better stability of crossed medial and lateral pins in comparison to two parallel lateral pins does not seem to be of practical importance. The risk of ulnar nerve injury by medial-pin fixation is not outweighed by significantly better clinical result. The rate of iatrogenic nerve injuries is 3-16% with the ulnar nerve being the most susceptible due to inadvertent pinning. Despite a high recovery rate, they are a nuisance for the patients. Fracture-related peripheral neuropathies have an incidence of 10-17%. With rare exceptions, concomitant nerve lesion recover spontaneously within a time range of 1-4 months. There is still controversy regarding the management of a post reduction pink, warm but pulseless hand with adequate capillary refill. Simple observation and conservative management lead to a favorable clinical outcome in most cases but cold intolerance or exercise-induced ischemic symptoms are a potential sequel.

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Section: Complete Displacement (Gartland Iiia B Holmberg III Von Lmentioning

confidence: 99%

Supracondylar Fractures of the Humerus in Children

Hasler

2001

Eur J Trauma

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“…Some prefer closed reduction and pinning for all displaced supracondylar fractures, including Gartland type II and type III. [4,7] while many agree with open reduction techniques and that type III fractures with a posterolateral displacement are less stable and should be treated by internal fixation 8 .Surgical indications are unsuccessful closed methods, severe displacement, severe ecchymosis in anterior part of elbow, vascular insufficiency and open fractures 6 . Complications are common.…”

Section: Discussionmentioning

confidence: 99%

Type - III supracondylar fracture of humerus effectively managed by closed reduction and pop application: A Case Report

Pagadpally

Nagakumar

Manohar

2014

Int J of Biomed & Adv Res

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“…Manual muscle test along with the clinical examination have been offered so far to assess the muscle strength, but the accuracy of this procedure is less than the objective assessment by using a device (2,4,(30)(31)(32)(33). However, according to the study conducted by MCKee et al (27), evaluation of the muscle strength has yielded more favorite results in our study than the posterior approach (triceps-splitting) or olecranon osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgical Treatment of Pediatric Supracondylar Humerus Fractures by Bilateral Triceps Approach

Shourin¹,

Moghadam²,

Gharehdaghi³

et al. 2014

Razavi Int J Med

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Background: Humerus supracondyllar fracture is one of the most common elbow injuries. Choice of treatment depends on grading of the displacement. Closed Reduction and pinning is the preferred method of treatment. Open reduction is indicated when we encounter neurovascular injury after closed reduction. One of the most important factors in the outcome of surgery is an appropriate approach that would provide better exposure with less soft tissue injury. Anterior, posterior, medial and lateral surgical approaches are used for this type of fracture. Objectives: Posterior bilateral triceps approach has less been studied so far. In this study we review the results of humerus supracondyllar fracture surgery by this approach. Patients and Methods:This study is a case series and includes 43 patients aged between 3.5-15 who referred to Imam Reza Hospital in Mashhad Iran from July 2006 to Octobre 2011 with humeral supracondylar fracture; Gartrland; type III. All patients had at least once, failed closed reduction. On admission, all patients with open fracture or neurovascular injury were excluded. All the patients were operated in one hospital and with the same method (bilateral triceps open reduction). Patients were followed up from 7 months to 2 years by the clinicians who were not involved in the selection of patients, the process of treatment and surgery. History, basic information, DASH questionnaire (disability of the arm and hand) physical clinical examination, particularly ROM (range of motion) and objective tests to measure muscular strength and radiographies were reviewed. Results: The mean age was 7.2 ± 2.4 years. The mechanisms of injuries were falling in 25 patients, skateboarding accident in 6 patients and 12 cases of motorized or non-motorized vehicle accidents. 8 patients required physiotherapy (maximum 20 sessions). Joint ROM in 91% of patients was complete. 4 patients (9%) had about 5-10 degree of limited range of extension (flexion deformity). The mean elbow flexion and extension strength in the injured hand was 80%-95% of the opposite one. No instability and laxity of the elbow joint was seen. The mean score of DASH was 30 ± 2.4. Reduction in the X-ray control after surgery was acceptable. No loss of reduction, nonunion and malunion, hardware failure, wound and infection complications, bleeding from the wound or hematoma formation at the site of surgery, neurological disorders after surgery and paresis were seen in postoperative examinations. Conclusions: By using Bilateral triceps approach for humerus supracondylar fracture, you can be able to have a very good exposure field as presented on pictures and due to less soft tissue damage in this approach, you need less immobilization time. After six weeks, the patient has full elbow range of motion, acceptable DASH score and no complication.

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Completely Displaced Supracondylar Fracture of the Humerus in Children

Cited by 55 publications

References 0 publications

Supracondylar Fractures of the Humerus in Children

Supracondylar Fractures of the Humerus in Children

Type - III supracondylar fracture of humerus effectively managed by closed reduction and pop application: A Case Report

Outcomes of Surgical Treatment of Pediatric Supracondylar Humerus Fractures by Bilateral Triceps Approach

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