Posterolaterally displaced and flexion-type supracondylar fractures are associated with a higher risk of open reduction

Novais, Eduardo N.; Carry, Patrick M.; Mark, Bryan J.; De, Sayan; Miller, Nancy H.

doi:10.1097/bpb.0000000000000314

Cited by 19 publications

(18 citation statements)

References 27 publications

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“…These circumstances also make these fractures more unstable and prone to open reduction [8,11,18]. Many authors support the view that family members should be informed in these situations that the likelihood of open reduction is higher [8,11,19]. Novais et al tried to identify factors predictive of conversion from closed reduction to open reduction and found that flexion-type fractures were significantly more likely to undergo this conversion [19].…”

Section: Discussionmentioning

confidence: 99%

Flexion-Type Supracondylar Humeral Fracture with Ulnar Nerve Injury in Children: Two Case Reports and Review of the Literature

et al. 2020

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Rare co-existance of disease or pathology Background: Supracondylar humeral fracture is a common fracture in the pediatric population. Although extension-type is the most common fracture pattern (97% to 98%), flexion-type supracondylar fractures are rarely encountered (2% to 3%). The combination of a flexion-type supracondylar humeral fracture with an ulnar nerve injury represents a real challenge for an orthopaedic surgeon. Case Reports: We report 2 cases of flexion-type supracondylar humeral fracture with ulnar nerve injury that open reduction and fixation was necessary because closed reduction could not achieve an acceptable result. An anterior approach to the elbow joint was chosen to explore whether any neurovascular structures were entrapped between the fragments. The ulnar nerve was not found to be compressed in the fracture site. After anatomic reduction, cross K-wire fixation of the fracture was performed. At 6-month follow-up, ulnar nerve injuries (in both patients) were resolved. Conclusions: These case reports enhance the existing literature that flexion-type supracondylar fractures with ulnar nerve injury are associated with higher rates of open reduction. Orthopaedic surgeons should be aware, and family members of those patients should be informed, that the likelihood of an open reduction in these types of injuries is extremely high. Open reduction is needed not only to achieve an anatomic reduction of the fracture but to make sure that the ulnar nerve is not entrapped between the proximal and distal fragment.

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Section: Discussionmentioning

confidence: 99%

Flexion-Type Supracondylar Humeral Fracture with Ulnar Nerve Injury in Children: Two Case Reports and Review of the Literature

et al. 2020

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“…The location of fracture displacement (posteromedial or posterolateral) did not change fluoroscopy or operative times. Novais et al recently found that posterolaterally displaced supracondylar fractures were more likely to be converted to open reduction, 13 but no patient in our series required ORIF, nor were there any iatrogenic type 4 supracondylar fractures, which may reflect surgeon experience.…”

Section: Discussionmentioning

confidence: 48%

A comparison of fluoroscopic exposure and operative time during treatment of displaced supracondylar elbow fractures in children

Hand

Bresnahan

Hennrikus

2017

Trauma

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Background: Intraoperative fluoroscopy can potentially expose the surgeon to levels of radiation beyond the recommended limits. This study aimed to assess the intraoperative differences between the fixation of types 2 and 3 supracondylar fractures for fluoroscopy time, operative time, direction of displacement, and potential cumulative risk of radiation to the surgeon. Methods: Retrospective chart analysis was used to review 74 consecutive subjects with type 2 or 3 extension supracondylar fractures over a six-year period. Closed reduction and percutaneous pinning with fluoroscopy was used in all cases. Fluoroscopy time and operative time were analyzed based on the fracture type, direction of initial displacement, and the number of K-wires used. Results: Type 2 supracondylar fractures require less fluoroscopy (mean: 16.8 s) and are shorter operations (mean: 19.2 min) when compared to type 3 (26.2 s and 25.1 min; p<0.05). The direction of displacement (posteromedial vs. posterolateral) did not influence operative (23.8 vs. 26.5 min) or fluoroscopy times (27.6 vs. 24.9 s; p>0.05). Conclusions: Type 3 supracondylar fractures utilize more fluoroscopy time and operative time than type 2 fractures. The direction of displacement did not affect fluoroscopy time or operative time. Surgeons who perform large numbers of closed reduction and percutaneous pinning may be exposed to excess amounts of radiation.

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“…O cirurgião deve estar atento à maior incidência de lesão nervosa e necessidade de redução aberta nessas fraturas. 12,41,46,47 As fraturas irredutíveis podem ser abordadas por via anteromedial, medial, ou posterior, preservando o periósteo anterior íntegro e permitindo a visualização direta do nervo ulnar. 4,46 Complicações Perda de redução A perda de redução ocorre em torno de 4% dos casos, sendo sua principal causa a fixação inadequada.…”

Section: Métodos De Fixaçãounclassified

“…The surgeon must be aware of the greater incidence of nerve damage and the need for open reduction in these fractures. 12 41 46 47 Irreducible fractures can be addressed anteromedially, medially, or posteriorly, preserving the intact anterior periosteum and allowing direct visualization of the ulnar nerve. 4 46 …”

Section: Treatmentmentioning

confidence: 99%

Manejo da fratura supracondiliana do úmero na criança

Poggiali

Nogueira

2020

Rev Bras Ortop (Sao Paulo)

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ResumoA fratura supracondiliana do úmero representa cerca de 3 a 15% de todas as fraturas na criança, sendo a que mais requer tratamento cirúrgico na população pediátrica. Apesar de os avanços no tratamento e na assistência terem contribuído para uma redução drástica da complicação mais temida, a contratura isquêmica de Volkmann, os riscos inerentes à fratura permanecem. Ausência de pulso palpável em fraturas tipo III é reportada em até 20% dos casos. Uma cuidadosa avaliação sensitiva, motora e vascular do membro acometido é fundamental na determinação da urgência do tratamento. Crianças mais velhas, sexo masculino, cotovelo flutuante, e lesão neurovascular são fatores de risco para a síndrome de compartimento. A cominuição medial pode levar à consolidação em varo, mesmo nos casos aparentemente inocentes. O método de escolha para o tratamento da fratura desviada é a redução fechada e fixação percutânea. Os erros na fixação e posicionamento inadequado dos implantes são as principais causas de perda de redução. Já existem evidências suficientes para a utilização de um terceiro fio de Kirschner, lateral ou medial, nas fraturas instáveis (tipo III e IV). Baseado nos conceitos atuais, um fluxograma para o tratamento da fratura supracondiliana do úmero na criança é sugerido pelos autores.

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Posterolaterally displaced and flexion-type supracondylar fractures are associated with a higher risk of open reduction

Cited by 19 publications

References 27 publications

Flexion-Type Supracondylar Humeral Fracture with Ulnar Nerve Injury in Children: Two Case Reports and Review of the Literature

Flexion-Type Supracondylar Humeral Fracture with Ulnar Nerve Injury in Children: Two Case Reports and Review of the Literature

A comparison of fluoroscopic exposure and operative time during treatment of displaced supracondylar elbow fractures in children

Manejo da fratura supracondiliana do úmero na criança

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