Pinning of supracondylar fractures in children – Strategies to avoid complications

Rupp, Markus; Schäfer, Christoph; Heiß, Christian; Alt, Volker

doi:10.1016/j.injury.2019.03.042

Cited by 14 publications

(11 citation statements)

References 55 publications

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“…Conservative treatment methods are recommended for Gartland type I fractures. [ 11 ] However, closed or open reduction followed by K-wire fixation is recommended in Gartland types II and III characterized by severe fracture displacement [ 3 , 12 , 13 ] In the literature, there are several mechanical and clinical studies investigating the ideal K-wire configuration for SHFs. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

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The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis

et al. 2021

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Objectives This study aims to investigate the effects of the angles created by the Kirschner wires (K-wires), which are applied in the percutaneous fixation of supracondylar humerus fractures with cross K-wire, with the fracture line on fracture stabilization. Patients and methods The study was conducted on distal humerus fracture models. Medial and lateral K-wires were placed in the fracture models. The angle between the fracture line and the K-wire inserted from medial was represented by alpha (α), while the angle between the fracture line and the K-wires inserted from lateral was represented by beta (β). A combination of various angles (30°, 45°, and 60°) was used in each model, where no two models had the same combination of α and β, resulting in nine different wire configurations. The simulation program was used to simulate the effects of forces, which were applied on rotation, flexion and extension directions, on these models. We measured and compared the stress on the wires and the displacement of fractures under different force configurations. Results When the force was applied in the counterclockwise direction, the stresses were 58 megaPascal (MPa) on medial K-wire, 24 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. When the force was applied in the clockwise direction, the stresses were 57 MPa on medial K-wire, 23 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. In all models, the increased α and β angles were translated into the decreased stress on K-wires at the fracture level and decreased displacement under rotational deforming forces. Despite having generally lower fracture displacement, the increased α and β angles led to variable changes in the stress on K-wires against flexion and extension forces. Conclusion In supracondylar humerus fractures, increasing the insertion angle of both medial and lateral K-wires augments stabilization and reduces displacement, particularly against rotational deforming forces.

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Section: Discussionmentioning

confidence: 99%

“…In the literature, there is no study supporting our results, particularly on the vertical transmission of wires. However, Gottschalk et al[ 11 ] showed that sending the wire over the capitellum increased stability. This can be attributed to two reasons.…”

Section: Discussionmentioning

confidence: 99%

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis

et al. 2021

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“…Supracondylar humerus fractures are the most usual elbow fractures in children. Their complications occur not only because of the fracture itself but also due to insufficient treatment (29,30). In general, restoration of coronal, sagittal, and rotatory alignment of the distal humerus and osteosynthesis with at least two pins, which fix both fracture fragments and do not cross at the fracture line, are recommended in treatment (5,(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

The Measurement Methods of Movement and Grip Strength in Children with a Previous Upper Extremity Fracture: A Comparative, Prospective Research

et al. 2019

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Background and Aims: Decreased range of motion of the elbow and forearm and decreased grip strength are potential findings following a childhood upper extremity fracture. Clinical follow-up is essential because spontaneous improvement is seen several months after the injury. Freehand measuring with a goniometer and hydraulic dynamometer is used to evaluate clinical result. The new methods are justified in avoiding human typewriting errors, thus improving patient safety. Nevertheless, their feasibility in child patients is unknown. This study aimed to evaluate congruence between the computer-assisted and the free-hand measuring methods. Materials and Methods: A total of 59 children with a previous supracondylar humerus fracture were clinically examined by means of free-hand (transparent goniometer and hydraulic dynamometer; Jamar, Lafayette Ltd.) and computer-assisted (E-Link System Packages, Biometrics Ltd.) methods. The range of motion and grip strength were measured separately using both methods. Agreement between the measurements was evaluated using the Bland–Altman method. Results: The results between the two methods were incongruent and the differences between measurements increased along with the mean of measurements in all categories except elbow extension. Rotational range of motions were smaller and grip strength was weaker while measuring with the computer-assisted method. The mean discrepancy was 0.97° (95% confidence interval = −2.46 to 0.53) for elbow extension and 7.97° (95% confidence interval = 6.60–9.33) for elbow flexion. Conclusions: Grip strength is used to evaluate impairment of hand function. The study method showed slightly lower results in grip strength. Range of motion is essential when evaluating the outcome of supracondylar humerus fracture, while >10° of change in elbow range of motion associate with impaired function. As compared with the gold-standard goniometer, the methods were not congruent. However, all differences were under 10° and probably beyond clinical importance. Because of its advantages in recording the outcomes to electronical charts, the computer-assisted method is recommended option in performing the follow-up of complicated pediatric supracondylar humerus fractures.

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“…Después de tres (60%) y seis meses (90%) los pacientes afectados experimentaron la recuperación de los nervios afectados. 6 El Dr. José Piñeiro y cols. en su estudio de 360 fracturas supracondíleas tipo III manejadas con fijación cruzada encontraron las siguientes secuelas: lesión neurológica en 3.3%, lesión vascular en 2.5%, infecciones superficiales en 6.9%, migración de clavos en 3.8%, cúbito varo en 3.3%, cúbito valgo en 2.0%, defecto rotacional en 8.0%, limitación flexo extensión en 1.0%.…”

Section: Introductionunclassified

Prevalencia de lesión nerviosa periférica por fractura supracondílea de húmero en pacientes pediátricos

Ruiz-Ruvalcaba¹,

Espinoza-Hernández²,

Cuevas-Mora³

2021

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Introducción: Las fracturas supracondíleas de húmero son las más frecuentes del codo en niños (50-60%), con pico máximo de 5-8 años, distribución 2:1 en hombres y predilección por el lado no dominante. Se producen por mecanismos directos e indirectos (95%). Pueden presentar lesión neurológica asociada en 5-19%. Objetivo: Identificar la prevalencia de lesión nerviosa por fractura supracondílea de húmero en pacientes pediátricos. Material y métodos: Captamos pacientes pediátricos con fractura supracondílea Gartland III atendidos en el periodo de marzo de 2020 a enero de 2021, fueron explorados en busca de lesión del nervio radial, mediano y cubital al momento de la atención primaria en urgencias y a los dos meses. Resultados: Se incluyeron 26 pacientes como muestra final. Se observó que 23% presentaron datos clínicos de lesión nerviosa en fracturas supracondíleas humerales. Conclusión: Se demostró que la edad de presentación, sexo, incidencia y recuperación de la lesión nerviosa en miembro torácico producida en fracturas supracondíleas de húmero en niños en nuestro hospital son similares a los diferentes parámetros evaluados en centros de alta concentración.

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Pinning of supracondylar fractures in children – Strategies to avoid complications

Cited by 14 publications

References 55 publications

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis

The Measurement Methods of Movement and Grip Strength in Children with a Previous Upper Extremity Fracture: A Comparative, Prospective Research

Prevalencia de lesión nerviosa periférica por fractura supracondílea de húmero en pacientes pediátricos

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