open reduction and Internal Fixation of displaced Supracondylar Fractures of humerus with Crossed K-wires via Medial Approach

Abstract

This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn's criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring

“…Nowadays, pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality 8 , 10 . Various methods of pinning have been described, including medial, lateral, combined medial and lateral, posterior and anteromedial approaches, with each having its own pros and cons 11 . However, pinning with K-wires comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity 12 .…”

Successful Immediate Re-implantation of an Extruded Femoral Segment: a Case Report

“…They described boiling the fragment and then sterilizing it in an autoclave immediately before re-implantation [5]. Since then, several authors described their successful experiences with different sterilization techniques including boiling, autoclaving, gamma irradiation, and soaking in chlorhexidine, povidone-iodine, and antibiotic solutions [3][4][5][6][7][8][9][10][11][12][13]. Autoclaving seems to be the most efficient method of decontamination but there are multiple concerns regarding loss of graft osteoinductive properties [4,14].…”

“…Furthermore, if the decision for re-implantation is made, how should it be sterilized and when should it be reimplanted. Due to the relative rarity of this scenario, clear protocols regarding sterilization, fixation, and reimplantation steps and techniques of extruded bone segments do not exist [3,4]. Therefore, sharing our individual experiences with dealing with such devastating scenarios in the surgical community may help in the formation of protocols and guidelines pertaining to this condition.…”

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“…Hence primary open reduction and k wire fixation may be still an option for displaced supracondylar fracture of humerus in children which has been shown comparable results with CRPP by various studies [26][27][28][29][30][31][32][33] . As controversies still persists regarding how late such fracture should be treated with surgery, our study evaluates early vs late treatment of displaced supracondylar fracture humerus in children.…”