Audit of Operative Management of Displaced Supracondylar Humeral Fractures in Children
Asian Journal of Orthopaedic Research,
Page 32-37
Abstract
Background: Supracondylar Humeral fractures (SCHF) constitute one of commonest fractures around elbow in children. Management of these fractures in very challenging. Majority of displaced supracondylar fractures are treated by closed manipulation and pinning. We did a retrospective study to analyze the functional outcome identify factors predisposing to complications.
Materials and Methods: Retrospective study of 40 patients with displaced supracondylar humerus fractures operated in Nizwa Hospital and who met our inclusion criteria were included in our study. All patients were treated with closed reduction and percutaneous pinning. We reviewed their case file records to record classification, operation notes, follow up and any complications noted.
Results: 28(70%) patients were male and 12(30%) female. The time elapsed from onset of trauma to surgery was on average 8.3 hours. The mean age of patients was 6.5 years with age range of 02-12 years. In 22(55%) patients fractures were fixed with cross pins and in 18(45%) patients with two lateral pins. The major cause of fractures was fall in 32(80%) cases followed by motor vehicle accidents in 08 (20%) cases. Superficial pin tract infection was recorded in 04(10%) Iatrogenic ulnar nerve injury were noted in 03(13.6%) patients with cross pinning. Loss of reduction in 01(2.5%) case due to pin migration was recorded. Final outcome assessment as per Flynn criteria was Excellent in 68% (mediolateral) 61% in lateral pinning group patients, Good in 22.8% (mediolateral) 22.3% in lateral pinning group patients, Fair in 9% (mediolateral) 11% in lateral pinning group patients, Poor 0% (mediolateral) 5.6% in lateral pinning group patients
Conclusion: Percutaneous Krischner wire fixation for displaced Supracondylar Humeral fractures in children is safe method with predictable outcome, however cross pinning is associated with more risk of iatrogenic ulnar nerve injury.
Keywords:
- Supracondylar fractures
- percutaneous pinning
- humerus
- gartland.
How to Cite
References
Khwaja MK, Khan WS, Ray P, Park DH. A retrospective study comparing crossed and lateral wire configurations in paediatric supracondylar fractures. The Open Orthopaedics Journal. 2017;11:432-438.
Brubacher JW, Dodds SD. Pediatric supracondylar fractures of the distal humerus. Curr Rev Musculoskelet Med. 2008;1:190-196.
Hassan MH Elbahri, Idris S Ahmed, Elrofai S Bashir, Yasir N Gashi, Alkadgry MH. Auditing the use of percutaneous pinning as a technique of fixation of unstable humeral supracondylar fractures in Sudanese children. 2010;5(4):265-270.
Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J. Pediatr Orthop. 1998;18:38-42.
Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959; 109:145-54.
Gosens T, Bongers KJ. Neurovascular complications and functional outcome indisplaced supracondylar fractures of the humerusin children. Injury. 2003;34:267–273.
Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatric Orthop. 2007;27(2):181-186.
Sevenson AL .The treatment of supracondylar fractures of the humerus by Krischner wire transfixation. J Bone J Sur Am. 1948;30:993-997.
Mostafa KM. Displaced supracondylar fractures of the humerus in children. Egypt Orthop J. 2017;52:153-157.
Guy SP, Ponnuru RR, Gella S, Tulwa N. Lateral entry fixation using three divergent pins for displaced paediatric supracondylar humeral fractures. ISRN Orthop. 2011; 137372. DOI: 10.5402/2011/137372
Talukder Md, Nazibullah Md, Mostafizur Rahman, Hasan M. Displaced supracondylar fracture humerus in children- Short term outcome of close reduction and percutaneous pin fixation having different pin configurations. International Journal of Emerging Technologies and Innovative Research. 2020;7(6):1059-1063.
Sahu RL, Percutaneous K. Wire fixation in paediatric supracondylar fractures of humerus. A retrospective study. Niger Med J. 2013;54(5):329-334.
Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatric Orthop. 2002;22:440-443.
Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1994;76:253-6.
Joiner ERA, Skaggs DL, Arkader A, Andras LM, Lightdale-Miric NR, Pace JL, et al. Iatrogenic nerve injuries in the treatment of supracondylar humerus: Are we really just missing nerve injuries on preoperative examination? J Pediatr Orthop. 2014;34:388–392.
Khademolhosseini M, Abd Rashid AH, Ibrahim S. Nerve injuries in supracondylar fractures of the humerus in children: İs nerve exploration indicated? J Pediatr Orthop B. 2013;22:123-126.
Ozcan M, Altinoz O, Erem M, Ciftdemir M, Copuroglu C, Turan FN. Prognosis and risk factors of nerve injuries in displaced pediatric supracondylar humerus fractures. Niger. J Clin Pract. 2020;23:647-653.
Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fracture of humerus in children. J Bone Joint Surg Am. 2004;86-A:702-707.
Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998;18:43-45.
Dekker A, Krijnen P, Schipper I. Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis. Injury. 2016;47(11):2391-2398.
Culp RW, Osterman AL, Davidson RS, Skirven T, Bora FW Jr. Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990;72:1211-1215.
-
Abstract View: 541 times
PDF Download: 258 times
