Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning

Abstract

Supracondylar fractures of humerus in children are common injuries. Displaced fractures areinherently unstable. Conservative treatment results in malunion. Open reduction and internalfixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102displacedsupracondylarfractures of humerus, agedbetween one andhalf yearto 13 years, weretreated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wireswereput.Above elbow plaster ofparis back slab was appliedinall cases for atleastfour weeks.Backslab,K-wireswere removedafterfourweeks andelbowrangeofmotionexercisewas started.Resultswere analyzed using Flynn’s criteria. All patients were followed up to 14th week postoperatively. Incross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively.We recommend this procedure fordisplacedsupracondylarfractures inchildrenas itis safeandcost effectiveprocedurewithacceptablecomplication rates.Key words: closed reduction, humerus, percutaneous pinning, supracondylar fracture

Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees

“…In the study by Devkota et al, 20 7 of the 79 patients in the crossed pinning group (6.86%) developed ulnar nerve injury. Although the etiology of the ulnar nerve injury that occurred in the lateral group remains unclear, the authors attribute it to either over drilling or over traction during manipulation.…”

“…In the study by Devkota et al, 20 there were 4 patients (3.92%) who developed poor range of motion, 3 were from the crossed, and 1 was from the lateral pinning group. In the study by Devkota et al, 20 there were 4 patients (3.92%) who developed poor range of motion, 3 were from the crossed, and 1 was from the lateral pinning group.…”

Treatment of Displaced Pediatric Supracondylar Humerus Fracture Patterns Requiring Medial Fixation

“…However, when combined with the remainder of studies previously mentioned, then there is a 0.53% rate of iatrogenic palsies with lateral-entry pins. 7,[12][13][14][15][16][17][18][19][20][21][22][23] It should be noted that Lyons et al 8 followed 17 children with iatrogenic ulnar nerve palsies and all of them had complete recovery of nerve function at 4 months, even with pin removal at the 3-week postoperative period.…”

Castries Prone Positioning for Open Reduction and Internal Fixation of Closed Gartland Grade III Humeral Supracondylar Fractures in Children

“…7,8 Close reduction and percutaneous pinning has been widely used, so is ORIF in the treatment of Gartland type III humeral supracondylar fracture. 2,9,10 The approaches for open reduction has been somewhat controversial with recommendation of different approaches; anterior, 11,12 medial, 13 lateral, 14 posterior, 15,16 and double incision (medial and lateral) 17 approaches have all been recommended by various investigators. The documented position has been by supine position where assistant might be required to hold and support the forearm throughout the surgical procedure.…”

“…1,2 Most of the fractures are extension type of injury in which there is posterior displacement distal fragment, this account for approximately 95% and anterior displacement in which the distal fragment is displaced anteriorly, this accounts for approximately 5%. Gartland classification has been widely used and this is into grade I in which there is no displacement, grade II in which there is posterior angulation but posterior cortex of the humerus is intact, and grade III fracture has a circumferential break in the cortex with total displacement (no cortical contact).…”