Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review

Pellegrin, Maurizio De; Fracassetti, Dario; Moharamzadeh, Désirée; Catena, Nunzio

doi:10.1016/j.injury.2018.09.046

Cited by 19 publications

(25 citation statements)

References 36 publications

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“… 28 , 29 The choice of position is based on surgeon experience, and prone position been shown to facilitate reduction, to use the C-arm more easily, and to reduce the rate of iatrogenic nerve injury. 30 , 31 However, it could make upper airways management, as well as treatment of polytrauma patients, more difficult; in addition, when the exposure of the antecubital fossa is needed for reduction or neurovascular exploration, the patient should be repositioned. 32 However, only 11 out of 184 (6%) respondents declared to position the patient prone, while 17 (9.2%) declared to perform the operation with the patient in this position only in selected cases.…”

Section: Discussionmentioning

confidence: 99%

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Pavone

Vescio

Accadbled

et al. 2022

Journal of Children's Orthopaedics

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Purpose: The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society. Methods: The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire. Results: The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of “crucial importance” for expected outcome of supracondylar humerus fractures treatment. Conclusion: Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated. Level of evidence: level II.

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Section: Discussionmentioning

confidence: 99%

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Pavone

Vescio

Accadbled

et al. 2022

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Considering the equal clinical and radiological results, different authors have listed the advantages of prone intraoperative positioning, such as a simpler reduction, a more comfortable use of C-arm and a reduction in nerve injuries. In case of posterior displacement, the gravity force correctly positions the distal humerus in the frontal plane [32]. Moreover, an easier gravity-guided reduction avoids the elbow hyperflexion, generally needed in patients treated in supine position [33].…”

Section: Discussionmentioning

confidence: 99%

“…In our sample, minor complications were encountered, but no nerve injuries; equally, Havlas et al [11] did not document ulnar nerve iatrogenic lesions in 455 SCHFs-affected children treated in prone position. On the other hand, the supine patient position requires minimal time [11], allowing for standard anesthesia management and the possibility to use an anterior, antero-medial or antero-lateral approach, if open reduction is needed [32,34,35].…”

Section: Discussionmentioning

confidence: 99%

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?

Pavone

Vescio

Riccioli

et al. 2020

JFMK

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Background: Supracondylar humerus fracture (SCHF) is a frequent injury in pediatric ages. Closed reduction and percutaneous pin fixation is a common treatment of displaced SCHF. Surgery is usually performed in the supine position; otherwise the prone position allows an easier fracture reduction and a safe placement of pins. The aim of study is to compare the clinical and radiographic results of the treatment of displaced SCHF, comparing two different intra-operative positionings. Methods: 59 SCHF affected children were retrospectively divided into supine (Group 1; n = 34) and prone (Group 2; n = 25), according to intraoperative position. All treated subjects were clinically evaluated according to Flynn’s criteria and Mayo Elbow Performance Score, and radiographically, including the measurement of the Baumann angle. Results: Clinically, Group 1, according Flynn’s criteria, had excellent cosmetic outcome in 32 subjects (94.1%). Mean MAYO Score was 96.0 ± 3.8. Group 2, according Flynn’s criteria, had excellent cosmetic outcomes in 23 subjects (92.0%). Mean MAYO Score was 97.8 ± 3.3. Radiographically, mean difference of Baumann’s angle between the injured limb and the normal limb was 5.5° ± 1.0° in Group 1 and 5.1° ± 1.1° in Group 2. Conclusion: Both supine and prone positioning achieved a satisfying outcome with similar results in joint function recovery and complications.

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“…Additionally, the flexion of the elbow made the measure of the Baumann angle more difficult. In a standard close reduction procedure, it was recommended to assess the alignment on the coronal plane in Jones’ view before pinning, due to the reduction in this position was more stable [ 22 , 30 , 31 ]. But, the measure of Baumann angle was usually more convenient and accurate in a “true” AP view (with the elbow in full extension and the forearm in full supination), although the fracture in this position is more unstable and easy to displace again [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

Chen

Lü

Shi

et al. 2021

BMC Musculoskelet Disord

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Background The supracondylar humerus fractures are the most common fracture in children’s elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. Methods We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn’s grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn’s grading scores were compared between groups. Results A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn’s grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). Conclusions There was no significant difference in reduction quality and Flynn’s scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.

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Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review

Cited by 19 publications

References 36 publications

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?

Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

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