Flexion Supracondylar Humerus Fractures: Ulnar Nerve Deficit Is a Risk for Open Reduction

Flynn, Kelly; Leddy, Kelly; Brusalis, Christopher M.; Flynn, John M.

doi:10.1542/peds.141.1_meetingabstract.669

Cited by 9 publications

(30 citation statements)

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“…Ulnar nerve injury may give a clue for a higher energy injury with associated softtissue damage, which might make closed reduction more difficult. [6] Pin leverage technique was reported to show an excellent result, [2] when satisfactory closed reduction after general anesthesia could not be achieved after three attempts. Similarly, the Kapandji technique could be an alternative to achieve a successful sagittal alignment.…”

Section: Modified Pin Leverage Technique In Closed Reductionmentioning

confidence: 99%

Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

Kim

Park

2021

JMSR

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Supracondylar humeral fractures are the most common injury of the elbow in children. Compared to flexion type fractures, extension type fractures are more common, up to 98%. Gartland classification has been used to guide the management of this injury, which is based on the extent of the displacement. If not adequately managed, completely displaced (type III) fractures may have a higher incidence of concomitant injury or complications, including neurovascular injury, compartment syndrome, or cubitus varus. Closed reduction followed by percutaneous pinning has been suggested as the standard operative method for the displaced supracondylar humeral fractures. However, these fractures can be challenging to reduce, with the traditional technique of closed reduction. Lateral-entry pinning is known as a sufficient method of fixation for this injury. However, the lateral pin only fixation technique may also result in loss of reduction in some particular patterns of fractures, such as fractures with medial column comminution. We discuss and describe the reduction techniques of completely displaced supracondylar humeral fractures, including technical tips and pitfalls for closed reduction and open reduction. We also discuss indications of medial pinning, and its safe method, when the lateral-entry pins may not achieve adequate stability.

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Section: Modified Pin Leverage Technique In Closed Reductionmentioning

confidence: 99%

Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

Kim

Park

2021

JMSR

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“…O cirurgião deve estar atento à maior incidência de lesão nervosa e necessidade de redução aberta nessas fraturas. 12,41,46,47 As fraturas irredutíveis podem ser abordadas por via anteromedial, medial, ou posterior, preservando o periósteo anterior íntegro e permitindo a visualização direta do nervo ulnar. 4,46 Complicações Perda de redução A perda de redução ocorre em torno de 4% dos casos, sendo sua principal causa a fixação inadequada.…”

Section: Métodos De Fixaçãounclassified

“…The surgeon must be aware of the greater incidence of nerve damage and the need for open reduction in these fractures. 12 41 46 47 Irreducible fractures can be addressed anteromedially, medially, or posteriorly, preserving the intact anterior periosteum and allowing direct visualization of the ulnar nerve. 4 46 …”

Section: Treatmentmentioning

confidence: 99%

“…Com incidência estimada de 1,7 para cada 1.000 indivíduos, é a fratura que mais requer tratamento cirúrgico na população pediátrica. 4,[8][9][10][11][12] O mecanismo de trauma mais frequente é a queda com a mão espalmada gerando a hiperextensão do cotovelo. Com isso, o olécrano age como um fulcro posterior no úmero, resultando na fratura tipo extensão, responsável por 97 a 98% dos casos.…”

Section: Introductionunclassified

“…With an estimated incidence of 1.7 per 1,000 individuals, it is the fracture that most requires surgical treatment in the pediatric population. 4 8 9 10 11 12 …”

Section: Introductionmentioning

confidence: 99%

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Manejo da fratura supracondiliana do úmero na criança

Poggiali

Nogueira

2020

Rev Bras Ortop (Sao Paulo)

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ResumoA fratura supracondiliana do úmero representa cerca de 3 a 15% de todas as fraturas na criança, sendo a que mais requer tratamento cirúrgico na população pediátrica. Apesar de os avanços no tratamento e na assistência terem contribuído para uma redução drástica da complicação mais temida, a contratura isquêmica de Volkmann, os riscos inerentes à fratura permanecem. Ausência de pulso palpável em fraturas tipo III é reportada em até 20% dos casos. Uma cuidadosa avaliação sensitiva, motora e vascular do membro acometido é fundamental na determinação da urgência do tratamento. Crianças mais velhas, sexo masculino, cotovelo flutuante, e lesão neurovascular são fatores de risco para a síndrome de compartimento. A cominuição medial pode levar à consolidação em varo, mesmo nos casos aparentemente inocentes. O método de escolha para o tratamento da fratura desviada é a redução fechada e fixação percutânea. Os erros na fixação e posicionamento inadequado dos implantes são as principais causas de perda de redução. Já existem evidências suficientes para a utilização de um terceiro fio de Kirschner, lateral ou medial, nas fraturas instáveis (tipo III e IV). Baseado nos conceitos atuais, um fluxograma para o tratamento da fratura supracondiliana do úmero na criança é sugerido pelos autores.

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The Costs of Interfacility Transfers for Nonurgent Pediatric Supracondylar Fractures

Mechas

Mayer

Iwinski

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Unnecessary transfers of nonemergent pediatric musculoskeletal injuries to regional trauma centers can be costly. The severity of fracture displacement in supracondylar humerus fractures dictates the risk of complications, the urgency of transfer and the need for surgical treatment. The purpose of this study is to examine the transfer patterns of Gartland type II pediatric supracondylar humerus fractures to identify strategies for improving patient care, improving health care system efficiency, and reducing costs. We hypothesize that there will be a high rate of unnecessary, emergent transfers resulting in increased cost. Methods: We retrospectively identified all pediatric patients that underwent treatment for a supracondylar humerus fracture between 2013 and 2018. Patient demographics, injury characteristics, chronological data, and surgical data were collected and analyzed from ambulance run sheets, transferring hospital records, and electronic medical records. Transfer distances were estimated using Google-Maps, while transfer costs were estimated using Internal Revenue Service (IRS) standard mileage rates and the American Ambulance Association Medicare Rate Calculator. A student t test was used to evaluate different treatment groups. Results: Sixty-two patients had available and complete transfer data, of which 44 (71%) patients were safely transferred via private vehicle an average distance of 51.8 miles, and 18 (29%) patients were transferred via ambulance on an average distance of 55.6 miles (P=0.76). The average transfer time was 4.1 hours by private vehicle, compared with 3.9 hours by ambulance (P=0.56). The average estimated cost of transportation was $28.23 by private vehicle, compared with $647.83 by ambulance (P=0.0001). On average, it took 16.1 hours after injury to undergo surgery and 25.7 hours to be discharged from the hospital, without a significant difference in either of these times between groups. There were no preoperative or postoperative neurovascular deficits. Conclusion: Patients with isolated Gartland type II supracondylar humerus fractures that are transferred emergently via ambulance are subjected to a significantly greater financial burden with no demonstrable improvement in the quality of their care, since prior research has shown these injuries can safely be treated on an outpatient basis. Potential options to help limit costs could include greater provider education, telemedicine and improved coordination of care. Level of Evidence: Level III (retrospective comparative study).

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Flexion Supracondylar Humerus Fractures: Ulnar Nerve Deficit Is a Risk for Open Reduction

Cited by 9 publications

References 0 publications

Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children

Manejo da fratura supracondiliana do úmero na criança

The Costs of Interfacility Transfers for Nonurgent Pediatric Supracondylar Fractures

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