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

Nacht, Jeffrey L.; Ecker, Malcolm L.; Chung, Stanley Μ. Κ.; Lotke, Paul A.; Das, Marianne

doi:10.1097/00003086-198307000-00031

Cited by 94 publications

(55 citation statements)

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“…Our study also showed the majority of patients with ulnar nerve injuries recovered completely during followup. For loss of reduction and deformity, inconsistent results were reported in previous studies [5,9,37,39,48,50,59]. Skaggs et al [50] retrospectively reviewed the results of reduction and pin fixation of 345 extension-type supracondylar fractures in children and found there was no difference regarding maintenance of fracture reduction between the crossed pins and the lateral pins.…”

Section: Discussionmentioning

confidence: 98%

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

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Section: Discussionmentioning

confidence: 98%

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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“…Supracondylar humerus fracture in children is an urgent condition, requiring rapid diagnosis and treatment, particularly due to the serious vascular and nerve complications associated with this injury (1,4,(5)(6)(7)(8)16,(23)(24)(25) . The surgeon's objective is to obtain anatomical reduction and reestablish function as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Supracondylar humerus fractures are caused by direct or indirect low-kinetic energy traumas, such as falls, which makes the occurrence of comminution, bone exposure or association with other fractures less frequent (1)(2)(3)(4) . Due to the anatomical characteristics of this region, and the variations in fractured fragments, immediate complications (vascular-nerve injuries, compartment syndrome) and late complications (vicious consolidation and angular deformities) can arise (5)(6)(7)(8) . Despite the various types of treatment, high morbidity and complications related to this type of fracture make treatment urgent and essential (1) .…”

Section: Introductionmentioning

confidence: 99%

Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

Carvalho¹,

Filho²,

Neto³

et al. 2012

Rev. bras. ortop.

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Objective: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. Methods: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. Results: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2 to 13 years (mean: 5.9 ± 2.48 years). Three fractures were classified as type II and 17 as type III. The length of follow-up ranged from four months to three years. Baumann's angle ranged from 69 to 100 (mean: 78.3) and cubitus varus was observed in four patients (values ranging from 84 to 100). According to the modified Flynn's criteria, 20 cases presented satisfactory outcomes: 17 excellent (85%), two good (10%) and one regular (5%). Two patients presented limited range of motion, two had paresthesia in the cubital region and one had transient neuropraxia of the ulnar nerve for six weeks. Conclusion: Percutaneous fixation with two crossed Kirschner wires leads to good results when carried out under direct viewing and with isolation of the ulnar nerve.

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“…상완골 과상부 골절은 소아의 주관절 부위 골절 중 50 ∼60%를 차지하는 가장 흔한 골절이다 12) . 상완골 과상부 골절의 합병증에는 볼크만 구축, 상완 동맥 파열, 화골성 근염, 주관절 운동 장애, 지연성 척골 신경 마비 등이 있을 수 있으나, 해부학적으로 전면은 구상와, 후면은 주두와로 구성되어 매우 얇기 때문에 골절의 정복과 고정 및 유지가 어려워 치료 후에도 주관절의 내반주 변형이 평균 30%에 서 발생한다 5,10,18) .…”

Section: 서 론unclassified

Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture

2010

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Purpose: To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view. Materials and Methods: A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared. Results: Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II. Conclusion: Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.

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

Cited by 94 publications

References 0 publications

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture

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