Management of displaced extension-type supracondylar fractures of the humerus in children.

Pirone, A M; Graham, H. Kerr; Krajbich, J. Ivan

doi:10.2106/00004623-198870050-00002

Cited by 419 publications

(296 citation statements)

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“…With regard to vascular injury, 10-20% of patients with a type III supracondylar fracture present with an absent pulse [30,31,34]; this condition is called ''pulseless supracondylar humerus fracture''. There is controversy about treatment if the pulse does not return but the hand is well perfused.…”

Section: Discussionmentioning

confidence: 99%

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Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Mazzini

Martín

Esteban

2010

Journal of Children's Orthopaedics

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Purpose There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed. We, therefore, performed a systematic review of the English literature to investigate the existing evidence regarding this issue. Methods A MEDLINE and EMBASE databases search was performed to identify articles that focused on the functional, cosmetic, and radiological outcomes, as well as post-surgical complications, regarding different surgical approaches used for open reduction and pinning in severely displaced supracondylar humerus fractures in children. One hundred and ninety-four articles were identified, of which seven were included for review. Data analysis included weighted means for all contingency tables and the Chi-square test. Standardized residues were studied when the Chi-square test was statistically significant. Statistical analyses were conducted using Stata 9.1/SE (StataCorp., College Station, TX) and P-values lower than 0.05 were considered to be statistically significant for all analyses. Results For functional outcome, a high frequency of excellent results was found within the lateral and medial approaches, and a high frequency of good results within the anterior approach. A high frequency of poor results was found within the posterior approach. For cosmetic outcome, there was a high frequency of fair results within the posterior and lateral approaches, and a high frequency of poor results within the posterior approach. No statistically significant difference regarding time to union, as well as complications, was found. Conclusion Our results suggest that a combined anteromedial approach could be the method which allows the achievement of better functional and cosmetic outcome according to Flynn's criteria. Time to union, as well as post-surgical complications, should not be an issue regarding surgical approaches used for open reduction and pinning in these fractures.

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Section: Discussionmentioning

confidence: 99%

“…Although irreducible fractures are uncommon (mostly due to interposition of the brachialis muscle, median nerve, and brachial artery [20]), 2-12% require open reduction [27,34]. Surgical exposure can be accomplished by a variety of approaches [21,[35][36][37].…”

Section: Introductionmentioning

confidence: 99%

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Mazzini

Martín

Esteban

2010

Journal of Children's Orthopaedics

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“…It can occur at any age but 4 to 10 years of age group is commonly affected. The mean age as reported by Rockwood 8 and Pirone 9 varies between 6 to 8 years. The same has been observed in our study which shows 5 to 8 years of age group being affected usually and the mean age being 7 + 1 years.…”

Section: Discussionmentioning

confidence: 86%

Gartland Type Iii Supracondylar Fracture Humerus; Surgical Management

Lal¹,

Chachar²,

Chohan³

et al. 2015

TPMJ

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male and female patients with Gartland type III supracondylar fracture of humerus presenting within 24 hour of injury, with age limit varying between 1-12 years were included in our study. The anteroposterior and lateral view X-rays were taken and evaluated for displacement and angulation, medial/ lateral displacement and angulation and rotation of distal fragment. After all aseptic measures, patient under general anesthesia, through posterior approach skin was incised, subcutaneous tissue dissected along the line of incision. Triceps apponeurosis was splitted and interposed soft tissue was released and fracture reduced and fixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateral view and an angle of 30 o -40 o in A/P view. Wound closed in layers, aseptic dressing applied and well-padded back slab with elbow in appropriate angle of flexion was applied and pulses were checked. Postoperatively the hand was held elevated. Plaster of parries black slab was removed after four weeks; the wires were removed after six weeks. The follow-up ranged from 3 to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteria for assessing the results were based on healing period, anatomical appearance, function and radiographic appearance. Results: Excellent results according to Mitchell-Adam's criteria were observed in 60 %. (120/200) cases, good results were observed in 27 % (54/200) cases. Overall excellent to good results were observed in 87% of cases. Conclusion: It is concluded that outcome of surgical treatment of supracondylar fractures of humerus (Gartland type III) fixed with medial and lateral placement of k-wires were excellent to good and it achieves stable fixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injuries were decreased as compared to closed reduction and percutaneous k-wiring. As this method is techinically easy, less demanding and effective for stabilization and can be applied for patients with these fractures. Key words:Kirschner wire, supracondylar fracture

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“…Displaced Gartland type III fractures have been seen as difficult cases by managing with closed reduction and pop cast due to loss of reduction and coronal tilt missed on radiograph resulting to cubitus varus deformity [5,6] . Closed reduction and percutaneous pinning provides the best cosmetic and functional results in early presentation [7][8][9][10][11] . Indications for open reduction and internal fixation includes: failed closed reduction, open fractures, brachial injury [12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

Int. J. Orthop. Sci.

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Purpose: Controversy still persists regarding optimum intervention time for late presentations of supracondylar fracture of humerus in children. We compared outcomes in early and late groups of presentation and management. Study design: We conducted prospective study comparing early and late open reduction and Kirschner wire fixation for Gartland type III supracondylar fracture of humerus in children aged less than 16 years. We analyzed results of 27 cases in early group and 19(8 lost) cases in late group. We compared duration of surgery, range of motion, and Flynn's criteria were used to evaluate outcome. Results: Thirty (65%) patients were male and 15(32.60%) had dominant limb involvement. Injury to surgery time was 53.63±41.03 hours in early group and 338.53±134.31 hours in late group (p<0.005). Pre-operative nerve injury was 6(13%) cases in early group. Bauman's angle at 12 weeks in early group was 70.04± 3.240 & in late group had71.42± 8.329. (p< 0.513). Loss of range of motion between groups was insignificant (p< 0.668). According to Flynn's, results were comparable between groups. Conclusion: We concludes that in cases of Garland type III supracondylar fracture of humerus of children open reduction & k-wire fixation is an effective method of treatment in both groups.

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Management of displaced extension-type supracondylar fractures of the humerus in children.

Cited by 419 publications

References 0 publications

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Gartland Type Iii Supracondylar Fracture Humerus; Surgical Management

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