Management of Displaced Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning

Abstract

INTRODUCTION: Supracondylar fracture of the humerus is common injury in children between the ages of 5 to 10 years. With males are affected twice high than females. The average age incidence was 8.3 years. Proper clinical and radiological examination is necessary for type of displacement and type of treatment. Percutaneous pinning of supracondylar fracture is certainly not a new technique (5), but it had excellent results in various series, comparatively with other techniques. Closed reduction and crossed percutaneous pinning is a reliable method of treatment for severely displaced supracondylar fractures of the humerus in children. MATERIALS: In our study 25 patients were treated with closed reduction and percutaneous pinning between 2009-2014. All 25 fractures were extension type III and closed variety. Left side was involved in 20 patients and Right side in 5 patients. The commonest mode of injury was by fall while playing and fall from bicyle. The displacement of the fracture was posteromedial in 19 patients and posterolateral in 6 patients. RESULTS: In our study we had 84% excellent or good results and 16% fair or poor results. Results were assessed according to the flynn's criteria. We had following complications after percutaneous pinning. In one patient ulnar neuropraxia developed because of the medial pin. After 1 week medial pin was removed and following that patient recovered completely. In our study one patient had radial and median nerve injury and developed myositis ossificans. Mild degree of volkmann's ischaemia and restriction of elbow movements. All these were because of the patient had massage and manipulation elsewhere before the treatment. Another patient had mild degree of cubitus varus deformity. DISCUSSION: Closed reduction with immobilization in cast and Dunlop's traction, skeletal traction necessitates either longer duration of hospitalization or supervision of the patient constantly. Open reduction and internal fixation always have the chance of infection and risk of myositis ossificans and associated loss of motion. CONCLUSION: Closed reduction and percutaneous pinning under image intensifier control offers several advantages such as accurate anatomic reduction, good stabilization, and early mobilization, less chances of joint stiffness and with low rate of malunion. And the hospital stay is shorter (5).