The Treatment of Displaced Supracondylar Humerus Fractures

Mulpuri, Kishore; Wilkins, Kaye E.

doi:10.1097/bpo.0b013e318255b17b

Cited by 104 publications

(90 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The pooled result of iatrogenic ulnar nerve injury in the current study is in agreement with previous reviews [1,3,5,38,40,52]. Babal et al [3] performed a meta-analysis which was derived almost exclusively from retrospective studies and concluded that the medial pin carried the greater overall risk of nerve injury as compared with a lateral-pin-only construct, and that the ulnar nerve was at risk of injury in patients who had medial pins.…”

Section: Discussionsupporting

confidence: 91%

“…Pin tract infection, superficial infection, reoperation, and compartment syndrome also were compared. Previous systematic reviews were aimed mainly at iatrogenic nerve injury, deformity, or loss of reduction [3,5,29,38,52]. Few meta-analyses or systematic reviews compared the postoperative functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Although several meta-analyses or systematic reviews of lateral entry versus crossed medial and lateral entry pinning for supracondylar fractures of the humerus have been reported [3,5,29,38,52,57], the conclusions drawn are based largely on results from nonrandomized controlled trials (nRCTs), which increases the likelihood that bias has affected those analyses. Randomized controlled trials (RCTs) are considered to be the most reliable form of scientific evidence in the hierarchy of evidence because they reduce spurious inferences of causality and bias.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Percutaneous pinning is a popular method of choice for supracondylar fractures [6][7][8] and has been reported to be a safe and cost-effective method that provides good functional results [7][8][9][10]. Even dislocated supracondylar fractures can be treated by repositioning and casting with an excellent functional outcome [11].…”

Section: Introductionmentioning

confidence: 99%

Increased incidence of distal humeral fractures and surgical treatment in 0- to 18-year-old patients treated in Finland from 1987 to 2010

Salonen

Pajulo

Lahdes-Vasama

et al. 2013

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Background Studies of pediatric and adolescent fractures in general report a significant increase in the incidence of upper-extremity fractures as well as in their surgical treatment. The aim of this study was to determine the trends of the incidence and treatment of distal humeral fractures in hospitalized 0-to 18-year-old patients in Finland. Method The study included the entire pediatric and adolescent (\19 years) population in Finland during the 24-year period from 1 January 1987 to 31 December 2010. Data on hospitalized patients were obtained from the nationwide National Hospital Discharge Registry where information is collected from all hospital categories (private, public, and other). Surgical treatment was categorized into three groups; (1) reposition with casting; (2) reposition or reduction and osteosynthesis; (3) reposition or reduction and external-fixation and other fixation methods. Patients were classified into three groups according to age: 0-6 years, 7-13 years, and 14-18 years. Annual incidences were calculated using the annual mid-year population census obtained from the Official Statistics of Finland. Results During the 24-year study period, there were a total of 12,590 hospitalizations with a main or secondary diagnosis of distal humeral fracture. In children aged 0-12 years the overall incidence of hospitalization increased 30 % during the 24-year study period, from 4.5 per 10,000 person-years in 1987 to 5.8 per 10,000 person-years in 2010. There were a total of 5,548 operations. During the study period, surgical treatment by repositioning or reduction with osteosynthesis due to a distal humeral fracture increased by fivefold in patients aged\6 years and by twofold in patients aged 7-12 years of age. The incidences of fracture and treatment in children older than 13 years did not change. Conclusion The incidence of distal humeral fractures and the incidence of repositioning with osteosynthesis increased remarkably in prepubertal children during the 24-year study period in Finland.

show abstract

“…5 The optimal pin configuration for displaced supracondylar fractures in children remains controversial. 6 This study evaluated the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures.…”

mentioning

confidence: 99%

Transolecranon and Lateral Kirschner Wire Fixation for Displaced Supracondylar Humeral Fracture in Children

Sharma

Kahal

Sharma

2015

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Purpose. To evaluate the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures. Methods. 39 boys and 11 girls aged 2 to 12 (mean, 7.27) years underwent closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for posteromedially (n=28), posterolaterally (n=7), or posteriorly (n=15) displaced extension-type supracondylar humeral fractures (Gartland types II and III). Results. Compared with the uninjured elbows, the injured elbows had a mean loss of flexion of 4.52° (p<0.001), a mean loss of extension of 1.7° (p=0.008), and mean change in carrying angle of 3.47° (p<0.001). According to the Flynn grading system, outcome was excellent in 35 patients, good in 9, fair in 2, and poor in 4. Outcome did not differ significantly between patients aged 2 to 4, 5 to 8, and 9 to 12 years or between those operated on within 24 hours of injury and those operated on 2 to 5 days after injury. One patient developed superficial pin tract infection, and 2 patients developed cubitus varus deformity. No patient sustained iatrogenic nerve injury. Conclusion. Transolecranon vertical and lateral Kirschner wire fixation is a viable option for displaced supracondylar humeral fractures in children, especially when there is massive swelling.

show abstract

The Treatment of Displaced Supracondylar Humerus Fractures

Abstract: Level II.

Cited by 104 publications

References 14 publications

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Increased incidence of distal humeral fractures and surgical treatment in 0- to 18-year-old patients treated in Finland from 1987 to 2010

Transolecranon and Lateral Kirschner Wire Fixation for Displaced Supracondylar Humeral Fracture in Children

Contact Info

Product

Resources

About