Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes

Challa, Sravya; Agarwal-Harding, Kiran J.; Levy, Paul S.; Barr‐Walker, Jill; Sabatini, Coleen S.

doi:10.1007/s00264-020-04694-8

Cited by 7 publications

(9 citation statements)

References 12 publications

(13 reference statements)

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“…In our cohort, 54% of the patients were boys, 75% of the patients had left-sided injuries, and 83% were injured by falling, all of which are similar to rates reported in the literature 19,25-30 . Delayed presentation among pediatric fracture patients has previously been reported to be as high as 28% in Malawi 17 .…”

Section: Discussionsupporting

confidence: 87%

“…S CHFs are common, but few studies have examined outcomes in low-and middle-income countries, where many patients are treated nonoperatively because of limited surgical capacity 19,25 . In our retrospective assessment of children with closed SCHFs treated nonoperatively at NKKDH in Malawi, we found that patients with Gartland type-II and III fractures had a significantly increased risk of clinical complications and functional impairment compared with patients with type-I fractures.…”

Section: Discussionmentioning

confidence: 99%

“…For Gartland type-II and III SCHFs, the literature supports surgical treatment with closed reduction and percutaneous pinning 20-22 . Few studies have examined the management and outcomes of SCHFs treated in low- and middle-income countries, where surgery is often unavailable 19 . In Malawi, most SCHFs are treated nonoperatively because of limited surgical capacity and expertise 23 , and patients’ clinical and functional outcomes remain unknown.…”

mentioning

confidence: 99%

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Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi

Mlinde¹,

Amlani

May

et al. 2021

JBJS Open Access

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Background: Displaced supracondylar humeral fractures (SCHFs) benefit from closed reduction and percutaneous pinning. In Malawi, many SCHFs are treated nonoperatively because of limited surgical capacity. We sought to assess clinical and functional outcomes of nonoperatively treated SCHFs in a resource-limited setting. Methods:We retrospectively reviewed all patients with SCHFs treated at Nkhotakota District Hospital (NKKDH) in Malawi between January 2014 and December 2016. Patients subsequently underwent clinical and functional followup assessment.Results: We identified 182 children (54% male, mean age of 7 years) with an SCHF; 151 (83%) of the fractures were due to a fall, and 178 (98%) were extension-type (Gartland class distribution: 63 [35%] type I, 52 [29%] type II, and 63 [35%] type III). Four patients with type-I fractures were treated with an arm sling alone, and 59 were treated with straight-arm traction to reduce swelling and then splint immobilization until union. All 119 of the patients with Gartland type-II and III or flexion-type injuries were treated with straight-arm traction, manipulation under anesthesia without fluoroscopy, and then splint immobilization until union. A total of 137 (75%) of the patients were available for follow-up, at a mean of 3.9 years after injury. The Flynn functional outcome was excellent for 39 (95%) with a type-I fracture, 30 (70%) with type-II, and 14 (29%) with type-III. The Flynn cosmetic outcome was excellent for 40 (98%) with a type-I fracture, 42 (98%) with type-II, and 41 (84%) with type-III. Forty (98%) of the children with a type-I fracture, 41 (95%) with type-II, and 32 (65%) with type-III returned to school without limitation. Controlling for sex, delayed presentation, medical comorbidities, injury mechanism, and skin blistering/superinfection during traction, patients with type-II fractures were 5.82-times more likely (95% confidence interval [CI], 1.71 to 19.85) and those with type-III fractures were 9.81-times more likely (95% CI, 3.00 to 32.04), to have a clinical complication or functional limitation compared with patients with type-I fractures.Conclusions: Nonoperative treatment of type-III SCHFs resulted in a high risk of clinical complications or functional impairment. These results illustrate the urgent need to increase surgical capacity in low-income countries like Malawi to improve pediatric fracture care.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi

Mlinde¹,

Amlani

May

et al. 2021

JBJS Open Access

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“…These fractures are frequently neglected and thus present late, particularly in developing countries. 12 Many researchers have already expressed their opinion in favor of emergent treatment of these fractures in order to resist complications. 13 In this study, there were a total of 30 (71.4%) male and 12 (28.6%) female.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Open reduction and internal fixation by Stabilization with cross K-wires in early versus late presentation of Supracondylar Humeral Fractures in Children

Basit¹

2022

Isra Med J

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Objective: To compare open reduction and internal fixation by stabilization with cross k-wires in early (within 6 days of injury) versus late (2 to 4 weeks) presentation of supracondylar humeral fractures in children. Study Design: A quasi experimental study Place and Duration: Department of Orthopedic, Lahore General Hospital, Lahore from 1st January 2021 to 30th June 2021. Methodology: A total of 42 cases (21 children in Group-A with early presentation and 21 in Group-B with late presentation) of Gartland’s type II and III humeral supracondylar fracture were included. All open reduction and internal fixation procedures were done by a single surgical team while post-surgical follow up consisted of 3-months. Functional and cosmetic outcome of surgery were observed in terms of decrease in carrying angle and elbow movements as per Flynn’s criteria. Results: Out of a total of 42 cases, there were 71.4% male and 28.6% female. The mean age of children in Group-A was 8.29±1.85 years while it was 7.43±2.06 years in Group-B. Mean procedure time was noted to be 0.91±0.35 hours in Group-A and 1.38±0.25 hours in Group-B (p<0.001). All cases were found to have satisfactory wound condition and bony union. Decrease in range of motion of elbow as 0-50, 6-100,and 11-150 in 10, 9 and 2 cases in Group-A respectively in comparison to 4, 14 and 3 cases in Group-B respectively (p=0.145). Functional outcome in 33.3% cases was excellent, good in 54.8% and fair in 11.9% cases while there was no difference in between both study groups (p=0.145). Conclusion: There is no significant difference in functional outcomes of early or late presentation in children undergoing open reduction and internal fixation for supracondylar fractures. Keywords: Supracondylar fracture, Humerus, Children, Early presentation, Late presentation, Open reduction, Internal fixation, K-wire stablization, Functional outcome.

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“…In countries with poor medical infrastructure and limited staff and resources, the humeral patella fractures in children under 16 are in the first place. In this context, the orthopedic treatment of fractures with surgery reccomendation leads to a large number of complications [1,2]. Salter-Harris type II fractures are low fractures, infracondylar, transphyseal fractures and involves the growth cartilage.…”

Section: Introductionmentioning

confidence: 99%

An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

Burnei¹

2021

MRAJ

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Background. The Salter-Harris II fracture is the most common transphyseal fracture of all types of fractures, per-total and for each bone extremity that has a growth cartilage. This type of fracture rarely occurs in the humeral palette and the metaphyseal fragment is located laterally or medially. No cases with ventral or dorsal metaphyseal fragment have been described. Purpose. To bring into notice a fracture, type Salter-Harris II, with posterior metaphyseal fragment, represented by a posterior corticospongiosis lysereum(thickening) and the olecranon fossa, associated with periosteal rupture and soft tissue interposition. Study design: Case report Methods: A 9-year-old patient shows signs of traumatic injury, as a result of a direct impact on the right elbow. After a radiological examination, the diagnosis of Gartland type III supracondylar fracture is established, a closed reduction is practiced and it is immobilized in a plaster cast. The radiological control after the orthopedic reduction highlighted an unsatisfactory reduction. A surgery and an open reduction and internal fixing in "double X" were performed. Results: The preoperative diagnosis of Salter-Harris II fracture, with posterior Holland fragment, was made with difficulty and may be a surprise on intraoperative exploration. Open anatomical reduction and the fixation in "double X" allowed a firm synthesis of the fracture, verification of stability, intraoperatively, lack of mobilization in the plaster splint, starting recovery on the first postoperative day and full recovery of elbow mobility in 32 days. Conclusions: Salter Harris type II fracture with posterior fragment dislocated by tilting, translation and asymmetric rotation, irreducible is operated by open reduction and internal fixation. The fixation in "double X" ensured a better stabilization and allowed the recovery of flexion and extension in 32 days from surgery.

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Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes

Cited by 7 publications

References 12 publications

Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi

Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi

Comparison of Open reduction and internal fixation by Stabilization with cross K-wires in early versus late presentation of Supracondylar Humeral Fractures in Children

An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

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