Open Reduction of Neglected Supracondylar Humeral Fractures With Callus Formation in Children

Abstract

Background: The standard treatment for supracondylar humeral fractures (SHFs) in children is closed reduction and percutaneous Kirschner (K)-wire fixation. In patients who present >14 days after injury and show callus formation, this procedure cannot be performed. There are 2 options in these cases: functional exercises with osteotomy performed at a later stage if cubitus varus is present, or immediate open reduction and percutaneous K-wire fixation. This study aimed to evaluate the outcomes of K-wire fixation through an anterior approach in children with neglected SHF and identify factors predicting the outcomes. Methods: This retrospective study assessed the files of 32 children treated for neglected SHF at our hospital between June 2015 and May 2018. An incision was made along the anterior transverse groove of the elbow. The callus was removed, the fracture was reduced, and K-wire fixation was performed. The outcome evaluation included the radiological Baumann angle, pin fixation construct, carrying angles, and the functional outcome was Mayo Elbow Performance Score and Flynn criteria. Binary regression analysis compared the functional outcome as the dependent variable with age, time from injury to operation, operation time, and the amount of callus. Results: The interval between injury and operation was 14 to 40 days (average, 22.4 d). Patients were followed for 12 to 36 months (average, 21.5 mo). Fracture healing took 5 to 8 weeks (average, 6.6 wk). No patient had a vascular injury or compartment syndrome. Twelve patients were intraoperatively assessed for radial and median nerve injury. No nerve repair was required. All nerve injuries recovered within 3 months. No iatrogenic ulnar nerve injury occurred. One patient had an infected incision. Binary regression analysis showed that the time elapsed between injury and operation (P=0.033) and Gartland type (P=0.008) were inversely correlated with outcomes; the longer the duration, the poorer the outcomes. Conclusions: The functional outcomes after open reduction and K-wire fixation through an anterior approach were poorer with longer time to surgery and Gartland type. Level of Evidence: Level III.

Short-term Follow-up of Early Reconstructive Surgery Management in Neglected Supracondylar Humeral Fractures

“…ROM flexion-extension of the elbow is very important in daily living activities. Limitations of these ROM tend to decrease quality of life, especially in flexion [7]. All of the patients in this case series had increases in flexion ROM and also decreased lag extension after early reconstructive surgery.…”

“…Displaced supracondylar humeral fractures are injuries that are difficult to treat and require procedures that are more difficult technically for orthopedic experts [4], [5], [6]. Supracondylar humeral fractures are usually treated in an acute state in pediatric patients [7]. Standard management for this fracture in children is through closed or open reduction and fixation by Kirshner (K)-wire.…”

“Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

“…The overall rate of complications after CRPP in type III fractures is approximately 8% [32]. [17] is the standard treatment and at the same time treatment options preferred by most surgeons for grade II and III supracondylar fractures with operative indication [16] [33][34][35]. After blind percutaneous pinning, satisfactory results are obtained in 98% of cases.…”

“…During the rst 14-60 days the hypertrophic callus can be peeled off. Evaluation of the results in children with SHF operated after 14 days by previous approach, analyzing the Bauman angle, K-wires con guration, carrying angles, Mayo Elbow performance score and Flynn criteria showed that the distant results are poor [16].…”

“Double X” Fixation for Rare and Particular Pediatric Supracondylar Humerus Fractures

“…During the first 14-60 days the hypertrophic callus can be peeled off. Evaluation of the results in children with SHF operated after 14 days by previous approach, analyzing the Bauman angle, K-wires configuration, carrying angles, Mayo Elbow performance score and Flynn criteria showed that the distant results are poor [16]. Lateral, medial or double approach (both lateral and medial), rigorous and non-aggressive dissection, pinning in "double X" without immobilization with rapid resumption of elbow mobility allows recovery of elbow mobility and reduces recovery period that can reach one year after immobilization in plaster cast [17].…”