Gartland type III extension supracondylar humerus fracture in a 10-year-old child. A surgical case report of an infrequent technique of medial and lateral column stabilization

INTRODUCTION AND IMPORTANCE

Supracondylar humeral fractures in children are the most common fractures of the elbow accounting for 16 % of all pediatric fractures. The treatment depends on age, the degree of displacement, and the presence of additional injuries.

PRESENTATION OF CASE

A case reports a 10-year-old girl with a Gartland type III supracondylar humeral fracture accompanied by anterior interosseous nerve neurapraxia preoperatively. The patient was treated operatively with medial and lateral column cross-pinning using four K-wires due to unsatisfactory closed reduction and lateral pinning only. Follow-up examinations performed in 1 and 6 months postoperatively revealed a 10° flexion contracture of the elbow with good functional and radiological results otherwise.

CLINICAL DISCUSSION

The main intervention was not focused on the AIN neuropraxia itself but on unsatisfactory closed reduction followed by cross-fixation with lateral pinning only. A standard anterior approach to visualize the fracture line, free interposing tissues, and perform stabilization was utilized. The unusual use of an additional medial pin formed a cross-frame to adequately support the medial cortex.

CONCLUSION

Closed reduction and percutaneous pinning are the preferred treatment options for most displaced supracondylar fractures. The open reduction via anterior approach and pinning for Gartland type III fracture gives good outcomes. Medial pinning is mandatory in particular fracture patterns and in case of unsatisfactory closed reduction. In the presented case medial and lateral column cross-pinning technique using four K-wires guaranteed no subsequent displacement on follow-up assessment and good results.

Judet type-IV fracture of the proximal end of the radius in a 7-year-old child. A surgical case report of open reduction and percutaneous pinning

INTRODUCTION

Fractures of the proximal end of the radius are rare and account for 1 % of all childhood fractures. The treatment of the proximal end of the radius in children depends on age, the degree of angular displacement, and the presence of additional injuries.

CASE PRESENTATION

This is a case of a 7-year-old child with a 90-degree angular displaced radial neck Judet type-IV fracture treated with open reduction and intramedullary stabilization with Kirschner wire. Follow-up examinations performed 4 and 12 weeks after the operative treatment revealed very good functional and radiological results.

DISCUSSION

In fractures of the radial neck with head displacement reaching 90an open reduction is the method of choice. An undoubted advantage of this method is the possibility of achieving a satisfactory reduction and fixation on the fragments. Although other operative treatment techniques including percutaneous K-wire leverage, Metaizeau technique, may be taken into consideration.

CONCLUSION

The method of open reduction and pinning is safe and gives good early outcomes as well as long-term results without leading to impairment of function or deformation of the elbow joint.

Is analog preoperative planning still applicable?-comparison of accuracy of analog and computer preoperative planning methods in total hip arthroplasty

Background

Preoperative planning is an integral part of total hip arthroplasty and has a significant impact on surgical technique and clinical outcome. The variety of types and sizes of endoprosthesis components makes the procedure more demanding and generates a need for accurate preoperative planning. The objective of this study was to analyze an analog method of preoperative planning of primary total hip arthroplasty based on templates overlaying on preoperative radiograms and compare its accuracy for predicting the size, both the stem and cup, with computer planning methods.

Methods

A retrospective cohort study based on 360 X-ray images of hip joints in 348 patients qualified for total hip arthroplasty between 2018 and 2019. The study group consisted of 136 men and 212 women, with an average age of 65 years (56 to 85 years). Material included both cementless and cemented endoprostheses.

Results

In the analyzed material, the accuracy of cup planning using the analog method was 85% (P<0.001) and 77% (P<0.001) in the planning of stem size. However, using the computer method, planning accuracy was 82% (P<0.001) for the cup and 72% (P<0.001) for the stem.

Conclusions

Both methods of preoperative planning remain effective. The analog method of preoperative planning is simple, precise, and repeatable in choosing the type and size of endoprosthesis components with an accuracy of 85% and 77% for the cup and stem respectively. The accuracy of planning depends on the type of endoprosthesis and in the case of the cemented endoprosthesis, it is lower than in cementless.