Effect of fracture location on rate of conversion to open reduction and clinical outcomes in pediatric gartland type 3 supracondylar humerus fractures

Tokyay, Abbas

doi:10.14744/tjtes.2020.23358

Cited by 3 publications

(3 citation statements)

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“…The eligible 49 studies all reported the proportion of cases with open and closed reduction 7,10,25-50,51-70 . The pooled overall proportion obtained for ORIF was 0.16 (95% CI = 0.14, 0.18; Table III; Fig.…”

Section: Resultsmentioning

confidence: 99%

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Transtrum,

Sanchez,

Griffith

et al. 2024

JBJS Open Access

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Background: Supracondylar humerus (SCH) fractures are some of the most common fractures in pediatric patients with surgery typically consisting of either open or closed reduction with internal fixation. The aim of this meta-analysis was to identify patient, injury, and administrative factors that are associated with treating pediatric SCH fractures with open techniques. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and CINAHL database searches were conducted for studies from 2010 to 2023 that made direct comparisons between open reduction and internal fixation (ORIF) and closed reduction and percutaneous pinning (CRPP) for treating SCH fractures in the pediatric population. The search terms used were “pediatric” AND “SCH fracture” OR “distal humerus fracture.” Screening, quality assessment, and data extraction were performed by 4 reviewers. After testing for heterogeneity between studies, data were aggregated using random-effects model analysis. Results: Forty-nine clinical studies were included in the meta-analysis. Summated, there were 94,415 patients: 11,329 treated with ORIF and 83,086 treated with CRPP. Factors that were significantly associated with greater rates of ORIF included obesity (p = 0.001), Gartland type IV fractures (p < 0.001), general neurological deficits (p = 0.019), and ulnar nerve deficits (p = 0.003). Gartland type II (p = 0.033) and medially displaced fractures (p = 0.011) were significantly associated with lower rates of ORIF. Secondary analysis showed cross-pinning constructs (p = 0.033) and longer hospital stays (p = 0.005) are more likely to be observed in patients undergoing ORIF compared with CRPP. Conclusion: This meta-analysis demonstrates that factors such as obesity, fracture displacement, and concomitant nerve deficits are more likely to require ORIF as opposed to CRPP. Level of Evidence: Therapeutic Level III.

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Section: Resultsmentioning

confidence: 99%

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Transtrum,

Sanchez,

Griffith

et al. 2024

JBJS Open Access

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“…Furthermore, we found that a high level of fracture was the only risk factor for type IIIB, which may be related to anatomical characteristics of the distal humerus in the transverse fracture. A high level of fracture usually has a smaller fracture “contact area” than the low type, which decreases the force of sliding friction and is more unstable ( 24 , 25 ). Therefore, type III flexion SCHFs with a high level of fracture are more likely to combine with the rotation of both X - and Y -axes.…”

Section: Discussionmentioning

confidence: 99%

Rotation of both X- and Y-axes is a predictive confounder of ulnar nerve injury and open reduction in pediatric lateral flexion supracondylar humeral fractures: A retrospective cohort study

et al. 2022

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BackgroundRotation of the distal fragment often occurs in flexion-type supracondylar humerus fractures (SCHFs), potentially leading to ulnar nerve injury (UNI) and open reduction. We analyzed the correlation between the rotations and UNI or open reduction and then assessed the risk factors associated with these rotations.MethodsData of Wilkins type III lateral flexion SCHFs were collected over a 10-year time period (1 January 2012 to 31 December 2021) in Children's Hospital of Fudan University Anhui Hospital. We defined the rotation of the distal fragment on the coordinate axis as two types, IIIA (X-axis rotation) and IIIB (the rotation of both X- and Y-axes) on X-ray radiography. Demographic data, the incidence of the two-type rotation, odds ratios (ORs) of UNI and open reduction, and risk factors of the rotation of both X- and Y-axes were analyzed.ResultsTotally, 152 patients were found (50 with IIIA vs. 102 IIIB). The UNI rate was 13%, and the open reduction rate was 22%. The UNI rate of the IIIB was five-fold higher than that of the IIIA [OR, 5.143; 95% confidence interval (CI), 1.414–23.125; p = 0.019], and the open reduction rate of the IIIB was nearly five-fold higher than that of the IIIA (OR, 4.729, 95%CI, 1.584–14.495; p = 0.003). In these two types, patients with UNI had a higher risk of open reduction than those without UNI (OR, 9.816; 95%CI, 3.503–27.508; p = 0.001). In the multiple regression analysis, a high level of fracture was identified as a risk factor for the rotation of both X- and Y-axes.ConclusionType IIIB lateral flexion-type SCHFs have higher rates of UNI and open reduction, and a high level of fracture is a risk factor associated with this type.

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“…Of the explored nerves, there were no divided nerves requiring repair or grafting. 16 1 6 weeks Unclear N 17 1 3 weeks Unclear; within 3 months N 19 3 4-6 weeks 6.7 months (mean) N 20 2 3 weeks 3 months N 21 2 4-6 weeks Unclear N 22 1 3 weeks 1 month N 6 23 4-6 weeks 6 months N 23 2 3.5 weeks 3 months N 24 11 3-4 weeks 4.5 months N 25 4 3 weeks 3 months Y 4 2 3 weeks 4 months N 27 5 3-4 weeks 7 months (mean) N 7 2 3-4 weeks 6 months (mean) N 28 3 3 weeks Unclear N 29 17 'once fracture healed' 6 months (mean) N 31 4 4 weeks 3.5 months (mean) N 32 52 3-4 weeks 2.5 months (mean)…”

Section: Early Intervention (Exposure)mentioning

confidence: 99%

Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: A systematic review

Graff

Dounas

Sung

et al. 2022

Journal of Children's Orthopaedics

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Purpose: Up to 4% of patients who undergo cross pinning of a pediatric supracondylar humerus fracture sustain an iatrogenic ulnar nerve palsy (IUNP). This study aims to summarize the evidence regarding the management of IUNP in this setting, and to identify if early intervention (early wire removal or exploration) leads to faster and/or more complete recovery of the ulnar nerve. Methods: A formal systematic review was undertaken, with databases searched including Ovid Medline, Embase and Cochrane central. This was performed in accordance with JBI methodology and PRISMA guidelines. Results: In all, 26 articles were included in final evaluation, reporting a total of 179 IUNP. In all, 153 cases (85%) were managed expectantly, reporting full recovery at final follow-up (average 4.5 months) in 140 cases (91%). There were 26 cases of IUNP which were managed with early wire removal and/or exploration, of which 22 had full recovery (85%). There were 17 cases of 179 (9%) which did not have full recovery. Conclusion: The majority of IUNP are managed expectantly, with approximately 90% achieving full recovery at final follow-up. The literature does not support early wire removal and/or exploration, possibly because the damage to the nerve is done at the time of wire placement.

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Effect of fracture location on rate of conversion to open reduction and clinical outcomes in pediatric gartland type 3 supracondylar humerus fractures

Abstract: tures occur more frequently in males and children aged 5-7 years. [2] While Gartland type I fractures are treated more conservatively, Gartland type III fractures require reduction and percutaneous pinning. [1,2] In cases, where closed reduc-

Cited by 3 publications

References 30 publications

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures

Rotation of both X- and Y-axes is a predictive confounder of ulnar nerve injury and open reduction in pediatric lateral flexion supracondylar humeral fractures: A retrospective cohort study

Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: A systematic review

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