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González-Morgado D, Blasco-Casado F, Guerra-Farfán E, de María Prieto JM, Jambrina-Abasolo U, Lara-Taranchenko Y, Ekhtiari S, Soldado F. Anterior approach for pediatric supracondylar humerus fractures: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T513-T523. [PMID: 38992464 DOI: 10.1016/j.recot.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE Systematic review of Level 2-4 evidence studies.
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Affiliation(s)
- D González-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - F Blasco-Casado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - E Guerra-Farfán
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J M de María Prieto
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canadá
| | - U Jambrina-Abasolo
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Y Lara-Taranchenko
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canadá
| | - F Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, España
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González-Morgado D, Blasco-Casado F, Guerra-Farfán E, De María Prieto JM, Jambrina-Abasolo U, Lara-Taranchenko Y, Ekhtiari S, Soldado F. Anterior approach for pediatric supracondylar humerus fractures: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:513-523. [PMID: 38852776 DOI: 10.1016/j.recot.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE Systematic review of Level 2-4 evidence studies.
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Affiliation(s)
- D González-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - F Blasco-Casado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Guerra-Farfán
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M De María Prieto
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - U Jambrina-Abasolo
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Y Lara-Taranchenko
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - F Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
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Zhu C, Feng Q, Ou Z, Zhong H, Tang X. Minimally invasive technique combined with external fixator in the treatment of pediatric flexion-type humeral supracondylar fractures. Sci Rep 2023; 13:22229. [PMID: 38097631 PMCID: PMC10721626 DOI: 10.1038/s41598-023-48158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
Flexion-type pediatric humeral supracondylar fractures are rare, and the reduction technique remains contradictory. A minimally invasive technique using percutaneous leverage reduction combined with an external fixator was described to achieve satisfactory reduction and avoid the open reduction in this study. The operation and clinical results of patients treated with this technique were retrospectively compared with traditional closed reduction. From January 2013 to January 2018, children diagnosed with displaced flexion-type humeral supracondylar fractures were included in this study. Patients were treated with closed reduction (Group A) or minimally invasive reduction technique (Group B). The external fixator fixation was then applied. The demographic information, as well as the clinical and functional results of the operation, were retrospectively reviewed and evaluated. There were twenty-two patients, ten in Group A and twelve in Group B. The mean duration of the operation in Group A was more prolonged than Group B (59 min versus 46 min, p < 0.001). No infection, nonunion, myositis ossificans, neurovascular injury or other complications related to the operation were observed by the time the fractures healed. During an average 36 months follow-up time, almost all children achieved good to excellent results except for one fair in Group A according to the MEPS and the Flynn criteria. This study introduced a safe and efficient minimally invasive technique for displaced flexion-type supracondylar humerus fractures. With the assistance of mosquito forceps, this leverage technique might achieve similar satisfactory clinical outcomes as traditional closed reduction but with a shorter surgical duration.
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Affiliation(s)
- ChengMing Zhu
- Department of Orthopaedic, Liuzhou Workers Hospital/the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, 545007, China
| | - QiYuan Feng
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - ZiXuan Ou
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - HaoBo Zhong
- Department of Orthopaedics, Huizhou First Hospital, Huizhou, 516000, China
| | - Xin Tang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Gerami MH, Naderian R, Nemati A, Abdoos P, Saeedi F. Anterior approach versus posterior approach for the open reduction of displaced pediatric supracondylar humerus fracture. J Orthop 2023; 42:70-73. [PMID: 37533627 PMCID: PMC10393512 DOI: 10.1016/j.jor.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background This study's objective was to compare the results and adverse outcomes of the anterior approach and posterior approach in patients with a type 3 Gartland pediatric supracondylar fracture who failed close treatment and indicated open reduction. Methods in this retrospective study patients with Gartland type 3 fracture who failed close reduction and required open reduction were enrolled in the study. Eligible patients underwent open reduction via anterior and posterior triceps sparing approaches. Patients were followed up 3, 6, and 12 months after the surgery. Study variables included age, sex, Bauman's angle, pin site infection, nerve injury, osteonecrosis, and elbow arc of motion. Results The study included a total of 83 patients. Surgery was performed on 49 patients using the posterior technique and 34 patients using the anterior approach. The mean age of patients was 6.78 ± 1.40 years. The mean age and the relative frequency of sex didn't differ significantly between study groups (P > 0.05). Two-way repeated measures ANOVA test showed that there was a statistically significant difference in elbow arc of motion in the anterior approach in comparison with the posterior approach, however, this increase was not clinically significant. In terms of adverse events including pin site infection, nerve injury, osteonecrosis, and cubitus varus, there was no statistically significant difference between the two approaches. Conclusion There was no clinically significant difference in elbow arc of motion and adverse events between the anterior approach and the posterior approach. Therefore, surgeons should choose the approach with which they are more familiar and comfortable.
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Affiliation(s)
- Mohammad Hadi Gerami
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramtin Naderian
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Amin Nemati
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pourya Abdoos
- Department of Surgery, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Fariba Saeedi
- Biostatistics Department, Isfahan University of Medical Science, Isfahan, Iran
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Liu S, Peng Y, Liu J, Ou Z, Wang Z, Rai S, Lin W, Tang X. Small incision reduction and external fixation for the treatment of delayed over fourteen days supracondylar humeral fractures in children. Front Pediatr 2022; 10:1039704. [PMID: 36405828 PMCID: PMC9668058 DOI: 10.3389/fped.2022.1039704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Supracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique. METHODS Between October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments. RESULTS A total of 11 children (aged 4-13 years) with delayed presentation (range, 14-22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria. CONCLUSIONS The results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.
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Affiliation(s)
- Shuai Liu
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - YingYing Peng
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JiaTong Liu
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZiXuan Ou
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZeZheng Wang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai, United Arab Emirates
| | - WeiFeng Lin
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin Tang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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