Controversial topics in the management of displaced supracondylar humerus fractures in children

Abstract

The aim of our study was to review the literature looking for the up to date information regarding these controversial topics. An electronic literature search was performed using the Medline/PubMed database. A closed reduction attempt should always be done first. It is more important to engage both columns as well as divergence of the pins no matter whatever configuration is applied. Time to surgery seems to be not an important factor to increase the risk of complications as well as open reduction rate. Usually neurological injuries present a spontaneous recovery. If there is absent pulse, we should follow the algorithm associated with the perfusion of the hand.

Medial mini-open versus percutaneous pin fixation for type 3 supracondylar fractures in children

“…[13,14] Some authors assert the importance of an additional medial K-wire to prevent reduction loss. [15,16] Incidence of iatrogenic nerve injury of 14.3% was recently reported in surgically treated cases of supracondylar humerus fracture. In the same study, the ulnar nerve was reported as that most commonly injured (82.1%), followed by the radial (7.7%) and median (5.1%) nerves.…”

Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

“…In particular, incidence peaks between the ages of 5-7 have been reported. 12,14,15 Supracondylar fractures of humerus are common in boys compared to girls. In our series, 72% were boys and 28% were girls.…”

Biomechanical comparison of different external fixator configurations for stabilization of supracondylar humerus fractures in children

“…If the ulnar nerve cannot be located, the use of a small incision (Gordon et al, 2001;Gosens & Bongers, 2003;Green et al, 2005;Zaltz et al, 1996) or nerve-stimulation is advised (Michael & Stanislas, 1996). Even if a nerve gets iatrogenically damaged, it usually recovers spontaneously within a certain time (Culp et al, 1990;D'Ambrosia, 1972;Dodge, 1972;Fowles & Kassab, 1974;Ikram, Joist et al, 1999;Lyons et al, 1998;Pretell-Mazzini et al, 2011;Rasool, 1998;Royce et al, 1991;van Vugt et al, 1988).…”