Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice?

Tarallo, Luigi; Novi, Michele; Porcellini, G.; Schenetti, Cecilia; Micheloni, Gian Mario; Maniscalco, Pietro; Catani, Fabio

doi:10.1016/j.injury.2021.02.071

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…The eligible 49 studies all reported the proportion of cases with open and closed reduction 7,10,25-50,51-70 . The pooled overall proportion obtained for ORIF was 0.16 (95% CI = 0.14, 0.18; Table III; Fig.…”

Section: Resultsmentioning

confidence: 99%

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Transtrum,

Sanchez,

Griffith

et al. 2024

JBJS Open Access

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Background: Supracondylar humerus (SCH) fractures are some of the most common fractures in pediatric patients with surgery typically consisting of either open or closed reduction with internal fixation. The aim of this meta-analysis was to identify patient, injury, and administrative factors that are associated with treating pediatric SCH fractures with open techniques. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and CINAHL database searches were conducted for studies from 2010 to 2023 that made direct comparisons between open reduction and internal fixation (ORIF) and closed reduction and percutaneous pinning (CRPP) for treating SCH fractures in the pediatric population. The search terms used were “pediatric” AND “SCH fracture” OR “distal humerus fracture.” Screening, quality assessment, and data extraction were performed by 4 reviewers. After testing for heterogeneity between studies, data were aggregated using random-effects model analysis. Results: Forty-nine clinical studies were included in the meta-analysis. Summated, there were 94,415 patients: 11,329 treated with ORIF and 83,086 treated with CRPP. Factors that were significantly associated with greater rates of ORIF included obesity (p = 0.001), Gartland type IV fractures (p < 0.001), general neurological deficits (p = 0.019), and ulnar nerve deficits (p = 0.003). Gartland type II (p = 0.033) and medially displaced fractures (p = 0.011) were significantly associated with lower rates of ORIF. Secondary analysis showed cross-pinning constructs (p = 0.033) and longer hospital stays (p = 0.005) are more likely to be observed in patients undergoing ORIF compared with CRPP. Conclusion: This meta-analysis demonstrates that factors such as obesity, fracture displacement, and concomitant nerve deficits are more likely to require ORIF as opposed to CRPP. Level of Evidence: Therapeutic Level III.

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Section: Resultsmentioning

confidence: 99%

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Transtrum,

Sanchez,

Griffith

et al. 2024

JBJS Open Access

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“…These results were comparable with other study. 18 Poor initial reduction or inadequate mechanical pinning were regarded to be the causes of the poor outcomes in type 2 and type 3 fractures when the criteria were not followed. Secondary displacement, with a difference in Baumann's angle of more than 5° between the postoperative radiograph and that taken at the time of wire removal.…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiological Outcome of Gartland Type 2 and 3 Supracondylar Fracture Humerus in Children Treated by Percutaneous Pinning

Kashmiri¹,

Khan²,

Farooq³

et al. 2021

PJMHS

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Background: The supracondylar humeral fractures were the most common fracture of the paediatric elbow with a high incidence between the ages 5 to 14 years. The aim of this study was that to compare the functional and radiological outcome between Gartland type II and III by percutaneous spinning surgery treating method in children. Study design: The study was cross sectional being conducted at the orthopedic department of Watim Medical College Rawat, Rawalpindi for the duration of six months, from June 2022 to December 2022. Methodology: The age range was >5 and <13 years. The children age, gender, affected area, post-operative loss of reduction and complications were recorder. The functional and radiological outcomes were follow up at least 7-8 weeks. Flynn’s criteria and Baumann angle were used to assess elbow movement after surgery. Results: A total number of patients was 110 operated for supracondylar humeral fracture which divide into 55 patients in each type of Gartland fractures. The maximum children 82%, p=0.01* were belong to age group 6-12 years which show significant. The left side 55%, p=0.009 was more injured as compared to right side. According to Flynn’s rating, Gartland 2 and 3 show significant improvement; p=0.001** of fractures after treatment. All patients had show satisfactory results in terms of loss of carrying angle, and elbow flexion. The data was analyzed by SPSS21. Conclusions: The percutaneous spinning show better clinical outcome of radiological and functional between two types of fracture Gartland 2 and 3 suprcondylar humeral fracture after treatment in children. Keywords: Humerus, Range of motion, injury, Fracture.

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“…Supracondylar fracture of the humerus is one of the most found fractures in children [1]. Treatment of a supracondylar fracture of the humerus requires adequate fracture reduction due to the presence of an active growth plate [2].…”

Section: Introductionmentioning

confidence: 99%

“…Supracondylar fractures of the humerus account for 55% -75% of all elbow fractures in children [1]- [3]. This can be caused by the laxity of the ligaments and thin bone structure in the supracondylar region of the humerus.…”

Section: Introductionmentioning

confidence: 99%

“…This can be caused by the laxity of the ligaments and thin bone structure in the supracondylar region of the humerus. Type III humeral supracondylar fracture according to Gartland, may be accompanied by neurovascular injury and cause complications such as malunion, elbow stiffness, and compartment syndrome [1], [4], [5]. The incidence of supracondylar fractures of the humerus Gartland type III is quite high, reaching 39.3% of all cases.…”

Section: Introductionmentioning

confidence: 99%

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Differences in Carrying Angle, Baumann’s Angle, Anterior Humeral Line and Dash Score between Children in the Age Group of Less than 5 Years and over 5 Years at 3 Months Post Open Reduction Internal Fixation Criss-Cross Wire Fracture Supracondylar Humerus Gartland Type III

Abigamika

Astawa

Aryana

et al. 2023

EJMED

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Introduction: Supracondylar humerus fracture is one of the most found fractures in children. In addition to adequate fixation, the role of age differences in the clinical outcomes of operative treatment of supracondylar humeral fractures is still a matter of debate. This study aimed to compare the clinical and radiological outcome of surgery in cases of Gartland type III supracondylar humerus fracture. Materials and Methods: This study used a cross-sectional design on the population of patient with Gartland type III supracondylar fracture. Patients were divided into 2 groups: age <5 years old (Group 1) and >5 years old (Group 2). The evaluation was carried out 3 months after surgery with open reduction internal fixation crisscross wire. The parameters assessed were Baumann’s angle, carrying angle, and anterior humeral line, and Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Difference between group were analyzed using the chi-square test. Results: There were a total of 34 patients included in this study. Patients >5 years old had a 1.85 times greater chance to have a post-operative carrying angle of >15o (95% CI 0.993-3.474; p = 0.037) and 2.75 times greater chance to result in post-operative Baumann’s angle >80o (95% CI 1,089-6,943, p=0.037). There were no significant differences in anterior humeral line (p=1) and DASH score (p=0.244) between groups. Conclusion: The result of surgery in supracondylar fracture of the humerus over 5 years old tend to have worse radiological outcome (carrying angle and Baumann’s angle) than patient younger than 5 years old. Thus, treatment of supracondylar fractures of the humerus aged more than 5 years requires more attention with adequate reduction and vigilance against complications that can affect the bone growth of pediatric patients.

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Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice?

Cited by 6 publications

References 18 publications

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Functional and Radiological Outcome of Gartland Type 2 and 3 Supracondylar Fracture Humerus in Children Treated by Percutaneous Pinning

Differences in Carrying Angle, Baumann’s Angle, Anterior Humeral Line and Dash Score between Children in the Age Group of Less than 5 Years and over 5 Years at 3 Months Post Open Reduction Internal Fixation Criss-Cross Wire Fracture Supracondylar Humerus Gartland Type III

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