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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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Da H, Zhou L, Xi QY, Xu CM. Modified lateral approach combined with medial percutaneous approach versus triceps tongue-shaped flap approach and bilateral triceps brachii approach for pin fixation in treatment of irreducible displaced pediatric supracondylar humeral fractures. Medicine (Baltimore) 2023; 102:e35158. [PMID: 37682149 PMCID: PMC10489252 DOI: 10.1097/md.0000000000035158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
To evaluate the clinical outcomes of the modified lateral approach combined with the medial percutaneous approach (MLACMPA) versus the triceps tongue-shaped flap approach (TTSFA) and the bilateral triceps brachii approach (BTBA) in the treatment of irreducible displaced supracondylar humeral fractures (SHFs) in children. Between March 2000 and July 2022, a total of 135 children who underwent open reduction and Kirschner wire cross internal fixation for irreducible displaced SHFs caused by trauma were retrospectively analyzed. According to the surgical approach, the patients were assigned to the TTSFA group (n = 36), the BTBA group (n = 40) and the MLACMPA group (n = 59). The duration of surgery, intraoperative blood loss, incision length, and elbow range of motion were compared. The 3 groups were similar in terms of mean age, sex distribution, and time from injury to operation. The duration of surgery, intraoperative blood loss, incision length and postoperative elbow range of motion in the MLACMPA group were significantly superior to those in the TTSFA group and BTBA group (P < .05). Compared the use of the TTSFA or the BTBA, using the MLACMPA for pin fixation in the treatment of irreducible displaced pediatric SHFs could significantly shorten the duration of surgery, reduce the operation trauma, facilitate earlier functional exercise of joints after operation and yield better elbow function.
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Affiliation(s)
- Hu Da
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Liang Zhou
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Qiao-Yun Xi
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
| | - Chang-Ming Xu
- Department of Orthopaedics, Lianshui County People’s Hospital, Lianshui, China
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Greve F, Biberthaler P, Castellani C, Singer G, Till H, Wegmann H. Beneficial Perioperative Aspects Favor the Use of Percutaneous Crossed Pinning over Antegrade Nailing in Pediatric Supracondylar Fractures-A Retrospective Comparative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050830. [PMID: 37238378 DOI: 10.3390/children10050830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
(1) Background: Displaced supracondylar humeral fractures in pediatric patients can be treated by either antegrade nailing (AN) or percutaneous crossed pinning (PCP). The aim of this study was to compare the intra- and perioperative management, complications and outcome of AN and PCP. (2) Methods: This retrospective study enrolled 271 individuals (median age 5 years, IQR 4-7 years) who underwent AN (n = 173) or PCP (n = 98). Patient history was analyzed for incidence of nerve injuries, postoperative treatment, postoperative malrotation, time of hospital stay, time to implant removal and revision rate. Operative procedures were investigated for duration and radiation exposure. (3) Results: PCP was associated with a significantly lower radiation exposure (dose area product: PCP mean 20.1 cGycm2 vs. AN mean 34.7 cGycm2, p < 0.001; fluoroscopy time: PCP mean 1.1 min, range 0.1-8.1 min, vs. AN mean 1.5 min, range 0.1-7.1 min, p < 0.001), duration of surgery (PCP mean 32.2 min vs. AN mean 48.3 min, p < 0.001) and time to implant removal (PCP mean 37 days vs. AN mean 113 days, p < 0.001). Cast removal was performed earlier in the AN group (PCP mean 30.2 days vs. AN mean 20.4 days, p < 0.001) and there were fewer iatrogenic nerve lesions (PCP: 24% vs. AN: 8%, p < 0.001). (4) Conclusions: In the investigated study population, the analyzed parameters seem to favor the use of PCP. The advantages of AN should be weighed against its drawbacks. For special indications, AN remains a relevant technique in supracondylar fracture treatment, and surgeons should be familiar with this procedure.
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Affiliation(s)
- Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Christoph Castellani
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria
| | - Helmut Wegmann
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Trauma Surgery, RoMed Hospital Wasserburg am Inn, Gabersee 1, 83512 Wasserburg, Germany
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Rehm A, Ashby E, Granger L, Ong JCY. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humerus fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:394. [PMID: 35986329 PMCID: PMC9392292 DOI: 10.1186/s13018-022-03286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
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Marson BA, Ikram A, Craxford S, Lewis SR, Price KR, Ollivere BJ. Interventions for treating supracondylar elbow fractures in children. Cochrane Database Syst Rev 2022; 6:CD013609. [PMID: 35678077 PMCID: PMC9178297 DOI: 10.1002/14651858.cd013609.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Elbow supracondylar fractures are common, with treatment decisions based on fracture displacement. However, there remains controversy regarding the best treatments for this injury. OBJECTIVES To assess the effects (benefits and harms) of interventions for treating supracondylar elbow fractures in children. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase in March 2021. We also searched trial registers and reference lists. We applied no language or publication restrictions. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing different interventions for the treatment of supracondylar elbow fractures in children. We included studies investigating surgical interventions (different fixation techniques and different reduction techniques), surgical versus non-surgical treatment, traction types, methods of non-surgical intervention, and timing and location of treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data and conducted GRADE assessment for five critical outcomes: functional outcomes, treatment failure (requiring re-intervention), nerve injury, major complications (pin site infection in most studies), and cosmetic deformity (cubitus varus). MAIN RESULTS: We included 52 trials with 3594 children who had supracondylar elbow fractures; most were Gartland 2 and 3 fractures. The mean ages of children ranged from 4.9 to 8.4 years and the majority of participants were boys. Most studies (33) were conducted in countries in South-East Asia. We identified 12 different comparisons of interventions: retrograde lateral wires versus retrograde crossed wires; lateral crossed (Dorgan) wires versus retrograde crossed wires; retrograde lateral wires versus lateral crossed (Dorgan) wires; retrograde crossed wires versus posterior intrafocal wires; retrograde lateral wires in a parallel versus divergent configuration; retrograde crossed wires using a mini-open technique or inserted percutaneously; buried versus non-buried wires; external versus internal fixation; open versus closed reduction; surgical fixation versus non-surgical immobilisation; skeletal versus skin traction; and collar and cuff versus backslab. We report here the findings of four comparisons that represent the most substantial body of evidence for the most clinically relevant comparisons. All studies in these four comparisons had unclear risks of bias in at least one domain. We downgraded the certainty of all outcomes for serious risks of bias, for imprecision when evidence was derived from a small sample size or had a wide confidence interval (CI) that included the possibility of benefits or harms for both treatments, and when we detected the possibility of publication bias. Retrograde lateral wires versus retrograde crossed wires (29 studies, 2068 children) There was low-certainty evidence of less nerve injury with retrograde lateral wires (RR 0.65, 95% CI 0.46 to 0.90; 28 studies, 1653 children). In a post hoc subgroup analysis, we noted a greater difference in the number of children with nerve injuries when lateral wires were compared to crossed wires inserted with a percutaneous medial wire technique (RR 0.41, 95% CI 0.20 to 0.81, favours lateral wires; 10 studies, 552 children), but little difference when an open technique was used (RR 0.91, 95% CI 0.59 to 1.40, favours lateral wires; 11 studies, 656 children). Although we noted a statistically significant difference between these subgroups from the interaction test (P = 0.05), we could not rule out the possibility that other factors could account for this difference. We found little or no difference between the interventions in major complications, which were described as pin site infections in all studies (RR 1.08, 95% CI 0.65 to 1.79; 19 studies, 1126 children; low-certainty evidence). For functional status (1 study, 35 children), treatment failure requiring re-intervention (1 study, 60 children), and cosmetic deformity (2 studies, 95 children), there was very low-certainty evidence showing no evidence of a difference between interventions. Open reduction versus closed reduction (4 studies, 295 children) Type of reduction method may make little or no difference to nerve injuries (RR 0.30, 95% CI 0.09 to 1.01, favours open reduction; 3 studies, 163 children). However, there may be fewer major complications (pin site infections) when closed reduction is used (RR 4.15, 95% CI 1.07 to 16.20; 4 studies, 253 children). The certainty of the evidence for these outcomes is low. No studies reported functional outcome, treatment failure requiring re-intervention, or cosmetic deformity. The four studies in this comparison used direct visualisation during surgery. One additional study used a joystick technique for reduction, and we did not combine data from this study in analyses. Surgical fixation using wires versus non-surgical immobilisation using a cast (3 studies, 140 children) There was very low-certainty evidence showing little or no difference between interventions for treatment failure requiring re-intervention (1 study, 60 children), nerve injury (3 studies, 140 children), major complications (3 studies, 126 children), and cosmetic deformity (2 studies, 80 children). No studies reported functional outcome. Backslab versus sling (1 study, 50 children) No nerve injuries or major complications were experienced by children in either group; this evidence is of very low certainty. Functional outcome, treatment failure, and cosmetic deformity were not reported. AUTHORS' CONCLUSIONS: We found insufficient evidence for many treatments of supracondylar fractures. Fixation of displaced supracondylar fractures with retrograde lateral wires compared with crossed wires provided the most substantial body of evidence in this review, and our findings indicate that there may be a lower risk of nerve injury with retrograde lateral wires. In future trials of treatments, we would encourage the adoption of a core outcome set, which includes patient-reported measures. Evaluation of the effectiveness of traction compared with surgical fixation would provide a valuable addition to this clinical field.
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Affiliation(s)
- Ben A Marson
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Adeel Ikram
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Simon Craxford
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Kathryn R Price
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, Nottingham, UK
| | - Benjamin J Ollivere
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
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Rees AB, Schultz JD, Wollenman LC, Moore-Lotridge SN, Martus JE, Schoenecker JG, Mencio GA. A Mini-Open Approach to Medial Pinning in Pediatric Supracondylar Humeral Fractures May Be Safer Than Previously Thought. J Bone Joint Surg Am 2022; 104:33-40. [PMID: 34673662 DOI: 10.2106/jbjs.21.00301] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Displaced pediatric supracondylar humeral fractures (SCHFs) are stabilized after reduction by smooth pins. Although some SCHFs are biomechanically stable after lateral-only entry pinning (lateral pinning), an additional medial entry pin (cross-pinning) confers superior stabilization in some SCHFs. There is a recognized risk of iatrogenic ulnar nerve injury with medial entry pinning. The best existing evidence has estimated an iatrogenic ulnar nerve injury rate of approximately 3.4% in cross-pinning. In similar studies, the rate of iatrogenic nerve injury (all nerves) in lateral pinning is estimated at 1.9%. This study aimed to use a large, single-center, single-technique (mini-open) retrospective case series to determine the rate of iatrogenic ulnar nerve injury in cross-pinning. METHODS Patients undergoing percutaneous cross-pinning via the mini-open technique for SCHFs from 2007 to 2017 were retrospectively reviewed. Injury characteristics, operative variables, fixation technique, and complications, such as iatrogenic nerve injury, were recorded. Patients who underwent operative treatment at another hospital, had no postoperative follow-up, or died due to polytrauma were excluded. RESULTS In this study, 698 patients undergoing cross-pinning during the study period were identified. Patients treated with cross-pinning had severe fractures, including a total of 198 preoperative neurovascular injuries (28.4%), 32 patients (4.6%) with skin tenting, and 19 patients (2.7%) with open fractures. Iatrogenic nerve injury was reported in 3 cases (0.43%), all of which affected the ulnar nerve. In 2 of 3 cases of iatrogenic nerve injury, the ulnar nerve symptoms resolved at a mean follow-up of 15 weeks. CONCLUSIONS The mini-open approach for medial pin insertion is safer than previous estimates. Here, in the largest single-center study of cross-pinning for SCHFs, the iatrogenic ulnar nerve injury rate of 0.43% was nearly 10 times lower than estimated rates from recent meta-analyses. Considering all nerves, the iatrogenic injury rate for this cross-pinning cohort was also lower than the estimated iatrogenic nerve injury rate for lateral pinning. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew B Rees
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jacob D Schultz
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Stephanie N Moore-Lotridge
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee.,Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey E Martus
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee.,Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G Schoenecker
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee.,Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee.,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt University, Nashville, Tennessee.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory A Mencio
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee.,Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
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7
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He M, Wang Q, Zhao J, Jin Y, Wang Y. Lateral entry pins and Slongo's external fixation: which method is more ideal for older children with supracondylar humeral fractures? J Orthop Surg Res 2021; 16:396. [PMID: 34154623 PMCID: PMC8215768 DOI: 10.1186/s13018-021-02541-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The standard surgical treatment for supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Given the need for greater fixation strength and higher risk of joint stiffness for children older than 8 years, external fixation is often performed for treating supracondylar humeral fractures in older children. The aim of this study was to compare the efficacy of lateral entry pins and Slongo’s external fixation for treating supracondylar humeral fractures in older children. Methods Children older than 8 years who underwent surgery for supracondylar humeral fractures at our hospital for surgery from January 2016 to December 2020 are to be retrospectively assessed. One group (n = 36) underwent internal fixation and percutaneous pinning with three lateral Kirschner wires, and the other group (n = 32) underwent Slongo’s external fixator surgery. The demographic data, operation duration, number of fluoroscopies, and fracture healing time were compared between both groups. The elbow joint function was evaluated 6 months after the surgery on the basis of fracture healing time, lifting angle, elbow joint range of motion (ROM), and Flynn score. The incidence of postoperative complications was also recorded. Results There was no significant difference between the two patient groups in terms of the demographic parameters. Compared to external fixation surgery, Kirschner wire surgery required shorter duration and fewer fluoroscopies (P < 0.05). Nevertheless, the fracture healing time was significantly less (P < 0.05), and the elbow ROM and Flynn scores were higher in the external fixator group compared to the Kirschner wire fixation group (P < 0.05). There was one case of secondary fracture displacement in the Kirschner wire group and one of pin tract infection in the external fixator group. No other iatrogenic injuries or complications were observed. Conclusion Maybe Slongo’s external fixator is a suitable alternative treatment option for supracondylar humeral fractures in children older than 8 years since it can achieve better fixation strength and early restoration of elbow joint movement with a lower risk of joint stiffness. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02541-z.
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Affiliation(s)
- Man He
- Department of Rehabilitation, Affiliated Hospital of Chengde Medical College, Chengde, Hebei, 067000, People's Republic of China
| | - Qian Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, Hebei, 067000, People's Republic of China
| | - Jingxin Zhao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, Hebei, 067000, People's Republic of China
| | - Yu Jin
- Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, Hebei, 067000, People's Republic of China
| | - Yu Wang
- Department of Orthopedics, Affiliated Hospital of Chengde Medical College, 36 Nanyingzi Street, Shuangqiao District, Chengde, Hebei, 067000, People's Republic of China.
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Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:366. [PMID: 34107972 PMCID: PMC8188794 DOI: 10.1186/s13018-021-02505-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Closed reduction and pinning entry fixation have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. However, controversy exists regarding the selection of the appropriate procedure. Hence, this meta-analysis was conducted to compare the effect of lateral and crossed pin fixation for pediatric SCHFs, providing a reference for clinical treatment. Methods Online databases were systematically searched for randomized controlled trials (RCTs) comparing lateral pinning entry and crossed pinning entry for children with SCHFs. The primary endpoints were iatrogenic ulnar nerve injuries, complications, and radiographic and functional outcomes. Results Our results showed that iatrogenic ulnar nerve injuries occurred more commonly in the crossed pinning entry group than in the lateral pinning entry group (RR = 4.41, 95% CI 1.97–9.86, P < 0.05). However, its risk between the crossed pinning with mini-open incisions group and the lateral pinning entry group was not significantly different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76). The loss of reduction risk was higher in the lateral pinning entry group than in the crossed pinning entry group (RR = 0.66; 95% CI 0.49–0.89, P < 0.05). There were no significant differences in the carry angle, Baumann angle, Flynn scores, infections, and other complications between these two groups. Conclusions The crossed pinning entry with mini-open incision technique reduced the loss of reduction risk, and the risk of iatrogenic ulnar nerve injury was lower than in the lateral pinning entry group. The crossed pinning entry with mini-open incision technique is an effective therapeutic strategy for managing displaced supracondylar humeral fractures in children.
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Affiliation(s)
- Huaguo Zhao
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongsandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Song Xu
- Department of Hepatobiliary Surgery, Shangyu People's Hospital of Shaoxing, 517 Citizen's Avenue, Shangyu, Shaoxing, Zhejiang, 312300, People's Republic of China
| | - Guanyi Liu
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongsandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jingyu Zhao
- Department of Orthopedics, Ninghai Hospital of Traditional Chinese Medicine, 1299 Taoyuan North Road, Ninghai, Ningbo, Zhejiang, 315600, People's Republic of China
| | - Shandong Wu
- Department of Orthopedics, Ninghai Hospital of Traditional Chinese Medicine, 1299 Taoyuan North Road, Ninghai, Ningbo, Zhejiang, 315600, People's Republic of China
| | - Linrui Peng
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongsandong Road, Ningbo, Zhejiang, 315040, People's Republic of China.
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Biomechanical Analysis of Sagittal Plane Pin Placement Configurations for Pediatric Supracondylar Humerus Fractures. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anterior to posterior (AP) pinning is the recommended sagittal pin configuration in divergent lateral entry coronal pinning of pediatrics supracondylar fractures. However, there was still a lack of evidence regarding alternative sagittal pins configurations. We aimed to compare the construct stiffness of alternative sagittal pin configurations by using synthetic bone models. Sixty synthetic pediatric humeri were osteotomized to create a supracondylar fracture. After the fracture reduction, all specimens were fixed in the coronal plane with divergent lateral entry pin configurations in four different patterns in the sagittal plane: AP, crossed, divergent and parallel sagittal pin configuration. Each configuration was tested with five loading patterns. The AP sagittal pin had significantly lower construct stiffness than the divergent (p = 0.003) and the parallel sagittal pin configuration (p = 0.005) in external rotation loading tests. The divergent sagittal pin had the highest construct stiffness in extension, valgus, and external rotation loads, but the parallel sagittal pin had lower construct stiffness under extension load than the divergent and crossed sagittal pin configurations. The divergent sagittal pin configuration provides greater construct stiffness than other sagittal pin configurations due to the maximal pin spreading distance at the fracture site and the pin angle lock mechanism.
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Abstract
Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years. Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries. Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present. Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively. Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction. Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury. About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion. Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.
Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049
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Affiliation(s)
| | | | - Luis Moraleda
- Department of Orthopaedic Surgery, Hospital Universitario La Paz, Spain
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11
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Gopinathan NR, Sajid M, Sudesh P, Behera P. Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration. Indian J Orthop 2018; 52:554-560. [PMID: 30237614 PMCID: PMC6142790 DOI: 10.4103/ortho.ijortho_462_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Supracondylar humerus fracture is the most common fracture around elbow in children. Closed reduction and percutaneous Kirschner wire (pin) fixation is the standard method of managing displaced extension type (Gartland Type II and Type III) supracondylar humerus fractures. The configuration of wires is debatable. Although two crossed K-wires are mechanically stable, there is an inherent risk of ulnar nerve injury. Lateral K-wires - parallel or divergent - are good alternative. This study was aimed at identifying the best configuration for the lateral wires. MATERIALS AND METHODS Patients with Gartland type 3 supracondylar humerus fractures were randomized by envelope method to receive closed reduction and K-wire fixation in either a parallel or divergent fashion. The patients were followed up at 3 weeks for wire removal and at 6 weeks and 3 months after surgery. Baumann's angle, functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Effect of delay in surgery was also evaluated as a secondary outcome. RESULTS Nineteen patients received fixation with parallel wires and 11 patients had divergent fixation. No loss of reduction was seen in any patient at 3 months. No statistically significant difference was seen in the Baumann's angles and outcome according to Flynn's criteria irrespective of the wire configuration (divergent or parallel). Furthermore, the delay in surgery was also found not to have a significant effect on the functional outcome. CONCLUSIONS Both parallel and divergent K-wire configurations provide satisfactory stability when accurate reduction and adequate fixation of the fracture has been done. Based on the limited number of patients in this study, one configuration cannot be judged to be superior to the other.
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Affiliation(s)
| | | | - Pebam Sudesh
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Prateek Behera
- Department of Orthopaedics, AIIMS, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Prateek Behera, Department of Orthopaedics, AIIMS, Bhopal, Madhya Pradesh, India. E-mail:
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Naik LG, Sharma GM, Badgire KS, Qureshi F, Waghchoure C, Jain V. Cross Pinning Versus Lateral Pinning in the Management of Type III Supracondylar Humerus Fractures in Children. J Clin Diagn Res 2017; 11:RC01-RC03. [PMID: 28969221 DOI: 10.7860/jcdr/2017/28481.10351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Closed reduction of supracondylar humerus fractures with K-wires has become the standard line of management with different opinions regarding the technique that is utilized. AIM To compare the functional and radiological outcomes of lateral and cross pinning technique in supracondylar fractures of humerus in children. MATERIALS AND METHODS A prospective study with 57 cases of displaced fracture supracondylar humerus, treated by lateral (Group A n=28) and cross pinning (Group B n=29), was conducted between May 2013 and May 2015. Independent sample student's t-test was done to assess the parameters like age, follow-up and duration of surgery. The results were expressed as mean with standard deviation and p<0.05 was considered as statistically significant. RESULTS As per the Gartland classification system, 46 (80.7%) patients had Type IIIA and 11 (19.2%) patients had Type IIIB fracture. The average surgical time was 28.3±1.6 minutes in Group A and 30±3.6 minutes in Group B (p=0.02). About, 3.5% patients in Group A had pin loosening. As per the Flynn criteria, 78.6% in Group A and 79.3% in Group B had excellent results. CONCLUSION No significant difference in terms of functional and radiological outcome was observed between both the techniques. Thus, both the techniques have equal results.
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Affiliation(s)
- Lokesh Gudda Naik
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Gaurav Mahesh Sharma
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Krishna Sudhakar Badgire
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Faisal Qureshi
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Chaitanya Waghchoure
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Vikas Jain
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
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Pradhan A, Hennrikus W, Pace G, Armstrong A, Lewis G. Increased pin diameter improves torsional stability in supracondylar humerus fractures: an experimental study. J Child Orthop 2016; 10:163-7. [PMID: 26972812 PMCID: PMC4837172 DOI: 10.1007/s11832-016-0722-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/21/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pediatric supracondylar humerus fractures are the most common elbow fractures seen in children, and account for 16 % of all pediatric fractures. Closed reduction and percutaneous pin fixation is the current treatment technique of choice for displaced supracondylar fractures of the distal humerus in children. The purpose of this study was to determine whether pin diameter affects the torsional strength of supracondylar humerus fractures treated by closed reduction and pin fixation. METHODS Pediatric sawbone humeri simulating a Gartland type III fracture were utilized. Four different pin configurations were compared. Specimens were subjected to a torsional load producing internal rotation of the distal fragment. The stability provided by 1.25- and 1.6-mm pins was compared. RESULTS The amount of torque required to produce 15° and 25° of rotation was greater using larger diameter pins in all models tested. The two lateral and one medial large pin (1.6 mm) configuration required the highest amount of torque to produce both 15° and 25° of rotation. CONCLUSIONS In a synthetic pediatric humerus model of supracondylar humerus fractures, larger diameter pins (1.6 mm) provided increased stability compared with small diameter pins (1.25 mm). Fixation using larger diameter pins created a stronger construct and improved the strength of fixation.
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Affiliation(s)
- Anupam Pradhan
- Pennsylvania State College of Medicine, 30 Hope Drive, Hershey, PA 17033 USA
| | - William Hennrikus
- Pennsylvania State College of Medicine, 30 Hope Drive, Hershey, PA 17033 USA
| | - Gregory Pace
- Pennsylvania State College of Medicine, 30 Hope Drive, Hershey, PA 17033 USA
| | - April Armstrong
- Pennsylvania State College of Medicine, 30 Hope Drive, Hershey, PA 17033 USA
| | - Gregory Lewis
- Pennsylvania State College of Medicine, 30 Hope Drive, Hershey, PA 17033 USA
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Abstract
Elbow fractures are common in pediatric patients. Most injuries to the pediatric elbow are stable and require simple immobilization; however, more severe fractures can occur, often requiring operative stabilization and/or close monitoring. This article highlights the common fractures and dislocations about the pediatric elbow and discusses the history, evaluation, and treatment options for specific injuries.
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Affiliation(s)
- Kevin J Little
- Division of Pediatric Orthopaedics, Hand and Upper Extremity Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2017, Cincinnati, OH 45229, USA; Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45229, USA.
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Zhao JG, Wang J, Zhang P. Is lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children? Clin Orthop Relat Res 2013; 471:2942-53. [PMID: 23653099 PMCID: PMC3734408 DOI: 10.1007/s11999-013-3025-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/23/2013] [Indexed: 01/31/2023]
Abstract
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, 0.10-0.89). 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.
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Affiliation(s)
- Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin, 300211 China ,Department of Orthopaedic Surgery, Clinical College of Orthopaedics, Tianjin Medical University, Tianjin, China
| | - Jia Wang
- Department of Traumatic Orthopaedics, Tianjin Hospital, Tianjin, China ,Department of Orthopaedic Surgery, Clinical College of Orthopaedics, Tianjin Medical University, Tianjin, China
| | - Peng Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
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Leaman C, Kotwal R, Williams P. A simple tip to improve the accuracy of crossed K-wire placement in the management of displaced paediatric supracondylar fractures of the humerus. Ann R Coll Surg Engl 2012. [PMID: 23131236 PMCID: PMC3954292 DOI: 10.1308/003588412x13373405387096c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- C Leaman
- Abertawe Bro Morgannwg University Health Board, UK.
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Leaman C, Kotwal R, Williams P. A simple tip to improve the accuracy of crossed K-wire placement in the management of displaced paediatric supracondylar fractures of the humerus. Ann R Coll Surg Engl 2012; 94:602. [DOI: 10.1308/rcsann.2012.94.8.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Leaman
- Abertawe Bro Morgannwg University Health Board, UK
| | - R Kotwal
- Abertawe Bro Morgannwg University Health Board, UK
| | - P Williams
- Abertawe Bro Morgannwg University Health Board, UK
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Enhanced biomechanical stiffness with large pins in the operative treatment of pediatric supracondylar humerus fractures. J Pediatr Orthop 2012; 32:201-5. [PMID: 22327456 DOI: 10.1097/bpo.0b013e31824536c8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various pin configurations have been recommended for the treatment of supracondylar humerus fractures on the basis of the choice between stability versus the risk of iatrogenic nerve injury. However, little attention has been paid to pin size. The purpose of this study was to evaluate the stability of large (2.8 mm or 0.110 inch) and small (1.6 mm or 0.062 inch) pin constructs in 6 configurations. METHODS A transverse fracture pattern was created by sectioning synthetic humeri in the midolecranon fossa. The specimens were then reduced and pinned in one of 6 configurations: 2 small pins (Kirschner wires) placed crossed or lateral divergent, 2 large pins (Steinmann pins) placed crossed or lateral divergent, or 3 small pins placed crossed or lateral divergent. All specimens were then tested in sagittal extension bending. We investigated the effect of pin configuration and cycle on the sagittal stiffness using multiple linear regression. RESULTS The 2 small lateral divergent pin configuration was significantly less stable than small crossed pins and large pins in a crossed or a lateral configuration. The addition of a third (lateral) pin to the small crossed pin construct made it significantly less stable than 2 large crossed pins. Although the stability between the remaining configurations was not significantly different, the 2 large crossed pins required the greatest torque to rotate the fragment 20 degrees. There was a significant reduction in torque as a function of cycle, suggesting a loss of fixation during cycling (P<0.05). CONCLUSIONS Large pins (2.8 mm) in any configuration and the placement of small pins (1.6 mm) in a crossed configuration provided more stable reduction in sagittal extension bending than did the conventional 2 small pins in a lateral divergent pin configuration. The most stable configurations involve crossing the medial and lateral pins. CLINICAL RELEVANCE There are more stable options than the traditional 2 small lateral pin configuration for fixation of unstable supracondylar fractures. The addition of a third pin is not always advantageous.
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Eberl R, Eder C, Smolle E, Weinberg AM, Hoellwarth ME, Singer G. Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children. Acta Orthop 2011; 82:606-9. [PMID: 21992087 PMCID: PMC3242959 DOI: 10.3109/17453674.2011.623574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ulnar nerve injury may occur after pinning of supracondylar fractures in children. We describe the outcome and compare the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing. METHODS Medical charts of all children sustaining this fracture treated at our department between 1994 and 2009 were retrospectively reviewed regarding the mode of treatment, demographic data including age and sex, the time until implant removal, the outcome, and the rate of ulnar nerve injuries. RESULTS 503 children (55% boys) with an average age of 6.5 years sustained a type-II, type-III, or type-IV supracondylar fracture. Of those, 440 children were included in the study. Antegrade nailing was performed in 264 (60%) of the children, and the others were treated with crossed pins. Iatrogenic ulnar nerve injury occurred in 0.4% of the children treated with antegrade nailing and in 15% of the children treated with crossed pinning. After median 3 (1.6-12) years of follow-up, the clinical outcome was good and similar between the 2 groups. INTERPRETATION Intramedullary antegrade nailing of displaced supracondylar humeral fractures can be considered an adequate and safe alternative to the widely performed crossed K-wire fixation. The risk of iatrogenic nerve injury after antegrade nailing is small compared to that after crossed pinning.
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Affiliation(s)
- Robert Eberl
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Christian Eder
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Elisabeth Smolle
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Annelie M Weinberg
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Michael E Hoellwarth
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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Queally JM, Paramanathan N, Walsh JC, Moran CJ, Shannon FJ, D'Souza LG. Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review. Injury 2010; 41:568-71. [PMID: 19782359 DOI: 10.1016/j.injury.2009.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 07/19/2009] [Accepted: 08/21/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury. METHODS We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period. The primary end points were a major loss of reduction as determined by radiological alignment and iatrogenic ulnar nerve injury. Secondary end points included clinical alignment, elbow range of motion and complications. RESULTS A total of 43 patients, who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type II and type III) of the humerus were reviewed with a mean follow-up time of 36 months. No major loss of reduction occurred. The mean change in Baumann's angle (4.2+/-1.6 degrees) between intra-operative and follow-up radiographs was not significant (p>0.05). No iatrogenic case of ulnar nerve injury occurred. The 'carrying angle' and 'return to function' in all children had returned to normal relative to the other side. Postoperative complications consisted of three patients developing pin-site infections, which were successfully treated. CONCLUSION Dorgan's lateral cross-wiring technique is an effective option in treating displaced supracondylar fractures of the humerus in children. It is as effective as the traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve injury.
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Affiliation(s)
- Joseph M Queally
- Department of Trauma and Orthopaedic Surgery, Mid-Western Regional Orthopaedic Hospital, Limerick, Ireland.
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Open reduction and bioabsorbable pin fixation for late presenting irreducible supracondylar humeral fracture in children. INTERNATIONAL ORTHOPAEDICS 2010; 35:725-30. [PMID: 20401656 DOI: 10.1007/s00264-010-1018-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 03/28/2010] [Accepted: 03/28/2010] [Indexed: 10/19/2022]
Abstract
The objective was to evaluate the availability and efficacy of internal fixation with absorbable poly-D: ,L: -lactic acid (PDLLA) pins for the treatment of late presenting irreducible Gartland type III supracondylar fracture of the humerus in children. Fifty-six cases of late presenting irreducible Gartland type III supracondylar fracture of the humerus in children were treated by open reduction and bioabsorbable PDLLA pin fixation from March 2005 to March 2008. The outcome of treatment was evaluated by the Mayo Elbow Performance Score (MEPS) and the criteria of Flynn. Fifty-six patients were followed up from 24 to 36 months (mean: 22 months). No displacement of bone fracture occurred, and all fractures healed within a normal time without wound infection; there were no cases of Volkmann's ischaemic contracture, myositis ossificans or iatrogenic injury of the ulnar nerve. No residual vascular deficits or iatrogenic nerve injury were noted; cubitus varus deformity occurred in one case. There were 49 excellent, four good and three fair results according to the MEPS; the rate of excellent and good outcome was 94.6%. All children but one had excellent cosmetic results according to the criteria of Flynn. All of the children and their parents stated that they would choose this treatment again. Treatment of late presenting irreducible Gartland type III supracondylar fracture of the humerus in children with bioabsorbable PDLLA pins provides sufficient stability and satisfactory efficacy. The absorbable implant has become popular for its avoidance of a second operation to remove the internal fixation, and the degree of patient satisfaction is high.
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Fractures in Children and Adolescents. Tech Orthop 2009. [DOI: 10.1097/bto.0b013e3181b58e5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients. J Child Orthop 2009; 3:265-9. [PMID: 19649669 PMCID: PMC2726872 DOI: 10.1007/s11832-009-0189-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/08/2009] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Type III supracondylar humeral fracture is a common cause of emergency hospitalization among children requiring surgical treatment. The configuration of the internal fixation material, surgical technique, and optimal timing of surgery (TS) have always been popular topics of debate. The TS in uncomplicated cases is usually determined by surgeons. METHODS In this study, we prospectively followed children with type III supracondylar fractures. We aimed to clarify the effects of injury side, gender, and post-injury delay on switching to open surgery and the ease of the reduction. RESULTS Based on our results, the probability of switching to open surgery increased by a factor of 4 every 5 h beginning 15 h after injury. Open surgery was necessary after 32 h. CONCLUSION Reduction became technically more difficult as TS increased.
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Zamzam MM, Bakarman KA. Treatment of displaced supracondylar humeral fractures among children: crossed versus lateral pinning. Injury 2009; 40:625-30. [PMID: 19394928 DOI: 10.1016/j.injury.2008.10.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/03/2008] [Accepted: 10/24/2008] [Indexed: 02/02/2023]
Abstract
This retrospective study evaluated different pinning configurations used in the treatment of displaced supracondylar humeral fractures among children, mainly regarding maintenance of fracture reduction and avoidance of complications. The fractures (41 type II and 67 type III) of 108 children (mean age 6.48 years) were treated by closed reduction and percutaneous pinning: 37 with crossed pins, 37 with two lateral pins and 34 with two lateral and one medial pin. Mean follow-up period was 7.4 months. Type III fractures fixed by two lateral pins were found significantly prone to postoperative instability, late complications and need for medial pin fixation. There was a significant relation between either delay to surgery or postoperative instability and occurrence of complications. Final outcome was significantly poorer in type III than in type II fractures. Fixation by two lateral pins only is not recommended for treating type III supracondylar humeral fractures, but could be used initially to fix severely unstable fractures to allow extension of the elbow before inserting a medial pin. Every effort should be made to avoid iatrogenic ulnar nerve injury while inserting the medial pin.
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Affiliation(s)
- Mohammed M Zamzam
- Department of Orthopaedics, King Khalid University Hospital, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia.
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