Sagittal Plane Malalignment in Paediatric Supracondylar Fractures of the Distal Humerus: A Review of the Literature

Rashid, Abbas; Abdul-Jabar, Hani B.; Bretherton, Christopher; Majed, Addie

doi:10.17554/j.issn.2311-5106.2016.03.172

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…The humerocapitellar angle of our patients on the operated side, average Gartland type IIA: 43.06 ± 2.19; type IIB: 40.34 ± 2.22; type III: 42.32 ± 2.81; and type IV: 40.63 ± 3.52 degrees. The average results for all fracture types were within the normal range [ 17 ]. A statistically significant difference was found between type IIA and type IV (p=0.032).…”

Section: Discussionmentioning

confidence: 99%

“…Our distribution was found to be similar to the distribution in the study by Silverstein et al [ 19 ]. There is limited literature regarding the long-term functional consequences of sagittal plane deformity in pediatric supracondylar fractures [ 17 , 20 ]. In their study, Silverstein et al did not find a significant relationship between the degree of sagittal deformity and joint range of motion and humerocapitellar angle [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning

Muslu,

Cengiz,

Aydın Şimşek

et al. 2023

Cureus

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Objectives: It was aimed to evaluate the clinical and radiological results of patients operated on with closed reduction and pinning due to pediatric supracondylar humerus fractures. Materials and methods: The radiological and clinical results of 100 patients operated on with closed reduction and percutaneous pinning for pediatric supracondylar humerus fractures in the Department of Orthopedics and Traumatology were examined between January 2015 and February 2022. Clinical results were evaluated by performing cosmetic and functional scores defined by Flynn. Closed reduction and percutaneous pinning techniques were used in surgical treatment. Results: In our study, 59 patients were male (59%), and 41 were female (41%). The average age of all patients is 6.21 ± 2.85 years. According to the Gartland classification, 21 patients' fractures were type IIA (21%), 12 patients' fractures were type IIB (12%), 51 patients' fractures were type III (51%), and 16 patients' fractures were type IV (16%). The average number of pins used in the treatment is 2.55 ± 0.50. The elbow bearing angle of the operated side of the patients was an average of 6.53 ± 3.29 degrees, the humerocapitellar angle was an average of 41.97 ± 3.08 degrees, and the lateral humerocapitellar angle was an average of 50.17 ± 3.58 degrees. Fifty-one patients had stage 0 (51%), 23 patients had stage 1 (23%), 23 patients had stage 2 (23%), and three patients had stage 3 (3%) residual sagittal plane deformity. According to the Flynn criteria, 92 patients had excellent functional results (92%), seven patients had good results (7%), and one patient had fair results (1%). Regarding cosmetic results, 91 patients had excellent results (91%), six patients had good results (6%), and three patients had fair results (3%). Conclusion: Supracondylar humerus fractures are common in children and can cause serious complications. Closed reduction and percutaneous pinning techniques are effective treatment methods in the treatment of displaced supracondylar humerus fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning

Muslu,

Cengiz,

Aydın Şimşek

et al. 2023

Cureus

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“…Several literature reviews have suggested that sagittal plane alignment may play an important role in elbow flexion and ROM [15,16]. It has been hypothesized that inadequate reductions of supracondylar fractures may result in loss of elbow flexion [14,17].…”

Section: Discussionmentioning

confidence: 99%

“…The distal humeral segment occasionally remains posteriorly displaced and or malrotated following CRPP. There is limited literature pertaining to the long-term functional significance of sagittal and axial plane deformity in pinned supracondylar fractures [13][14][15][16][17], and none describe the significance of an anterior osseous fragment that is often created. In the current study, we attempted to determine the relationship between quality of reduction in the sagittal and axial planes, osseous resorption and correlation to ROM.…”

Section: Discussionmentioning

confidence: 99%

Range of motion following percutaneous fixation of pediatric supracondylar humerus fracture is independent of anterior osseous fragment resorption

Silverstein

Meltsakos

Dedhia

et al. 2020

Journal of Pediatric Orthopaedics B

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The objective of this study was to understand postoperative resorption of the anterior osseous fragment following closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures and its effect on final range of motion (ROM). Eighty-six patients that underwent CRPP had sagittal and or axial plane deformities resulting in an anterior fragment. Humerocapitellar angle (HCA), anterior humeral line (AHL) and angle of rotation (AoR) were measured. A total of 11 (12.8%) patients failed to resorb the anterior fragment, 10 (90.9%) had satisfactory ROM. HCA initially was acceptable in 40 (46.5%) patients, and 37 (92.5%) demonstrated acceptable ROM. Final HCA was acceptable in 44 (51.2%) patients and 42 (95.4%) had acceptable final ROM. AHL was in the anterior third of the capitellum in 35 (40.6%) patients and 33 (94.3%) had acceptable ROM. Final AHL was in the anterior third of the capitellum in 43 (50.0%) patients and 41 (95.3%) had acceptable final ROM. No difference was found between acceptable ROM and HCA or AHL at either follow-up. Sixtyfive and 21 patients had an AoR of 0° and between 23 and 36°, respectively. A total of 59 (90.7%) patients with an AoR of 0°, and 18 (85.7%) patients with an AoR of 23-36° displayed acceptable ROM. A total of 57 (87.7%) patients with an AoR of 0° and 18 (85.7%) with an AoR of 23-36° resorbed the anterior fragment. No association was found between rotational deformity and postoperative ROM or fragment resorption. Postoperative sagittal and axial plane alignment, HCA, AHL, AoR and resorption of the anterior osseous fragment does not correlate with final ROM.

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“…Previous studies and systematic reviews have been conducted to provide clarification on optimal pinning of supracondylar fractures, ranging from biomechanical analysis of configuration (8)(9)(10)(11)(12), entry point (13,14), pin size (11,13,15), number of pins (13,16,17), pin separation at the fracture site (8,18,19), and clinical outcome (4)(5)(6)20,21). The propensity for children to remodel mild deformities resulting from loss of position (22,23) and the frequent use of cast immobilization post fixation (24) may allow the use of pin configurations with diminished stability.…”

Section: Introductionmentioning

confidence: 99%

Pediatric distal humeral supracondylar fracture – achievement of optimal pinning configuration

Chong¹,

Qureshi²

2022

Acta Orthop Belg

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Pediatric supracondylar humeral fracture is com- monly managed using closed reduction and per- cutaneous Kirschner wires pinning. However, there is no consensus on optimal pinning configuration in the literature. Our study aims to review the pinning configuration in our department, correlate our results with the available literature, and suggest the optimal configuration using basic biomechanics principles. We performed a retrospective review on children that were treated with K-wire pinning for supracondylar fracture at our institution between August 2017 and August 2019. Intra-operative antero-posterior view fluoroscopic images were used to measure the pin separation ratio (PSR), pin crossing angle (PCA), medial inclination angle (MIA) and lateral inclination angle (LIA). Pearson Correlation was used to identify the relationship between the variables. Ninety-one patients were included for analysis (39 male: 52 female), with a mean age of 6. Average PCA in the crossed pin and lateral-entry only technique CA was 75° and 12°, respectively. Mean crossed pin and lateral-entry only technique PSR is 0.54 and 0.17, respectively. There was a significant difference in both mean PSR and PCA between the configurations (p <0.01). In subgroup analysis, optimal PSR > 0.33 and PCA >90° were best achieved in crossed pinning using 1 medial and 2 lateral pins. Assessing the biomechanical characteristics of the different fixation techniques, we have found that 2 lateral divergent pins and 1 medial pin using the crossed pin technique optimized both the PSR and PCA. We would recommend this configuration to optimize the stability of the fixation construct.

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Sagittal Plane Malalignment in Paediatric Supracondylar Fractures of the Distal Humerus: A Review of the Literature

Cited by 6 publications

References 20 publications

Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning

Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning

Range of motion following percutaneous fixation of pediatric supracondylar humerus fracture is independent of anterior osseous fragment resorption

Pediatric distal humeral supracondylar fracture – achievement of optimal pinning configuration

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