Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children

Abstract

At the final follow-up, using Flynn's overall modified classification, the clinical result was considered to be excellent in 99 patients (91.6%), good in five (4.6%) and poor in four (3.7%). All the poor results were due to a poor cosmetic result, but had good or excellent function. Technical error in the initial management of these four cases was thought to be the cause of the poor results. The protocol described resulted in good or excellent results in 96% of our patients, providing a safe and efficient treatment for displaced supracondylar fractures of the humerus even in less experienced hands. Extension supracondylar fracture of the humerus is the most common fracture around the elbow in children.

Cross pinning of supracondylar fractures from a lateral approach. Stabilization achieved with safety

“…The functional and cosmetic results using Flynn's score were available in 75 of the children treated. Our 93% good to excellent functional results of all supracondylar fractures treated by closed reduction was comparable to a similar series from France, in which 96% excellent and good results were achieved [4]. Our cosmetic results using Flynn's score of 93% excellent and 7% good results with no poor results was even better than the French series.…”

“…These figures compare favorably to the 60% rate of closed reduction achieved by Millis et al [18], and 78% by Mazda et al [4]. One large series from Boston [19] achieved a rate of 92% of initial closed reduction, which was possibly a reflection of their vast experience at that institution.…”

“…Pin infections are described in up to 18% of cases [4]. In a series with lateral cross pinning with proud wires the pin complication rate was 30% [23].…”

“…In our review of the most current literature, it appeared that closed reduction and percutaneous pinning is the treatment of choice in most pediatric trauma centers [2,3,4,5,6,15,16,17].…”

“…Closed reduction and percutaneous pinning are now widely accepted throughout the English-and French-speaking literature [2,3,4,5,6], while open reduction and pinning is still more commonly practiced in Germany [7]. There are various options for the pattern of K-wire fixation of displaced supracondylar fractures.…”