Supracondylar Humeral Fractures in Children

Abstract

Operative fixation is indicated for most type-II and III supracondylar humeral fractures in order to prevent malunion. Medial comminution is a subtle finding that, if treated nonoperatively, is likely to lead to unacceptable varus malunion. Angiography is not indicated for a pulseless limb, as it delays fracture reduction, which usually corrects the vascular problem. A high index of suspicion is necessary to avoid missing an impending compartment syndrome, especially when there is a concomitant forearm fracture or when there is a median nerve injury, which may mask symptoms of compartment syndrome. Lateral entry pins have been shown, in biomechanical and clinical studies, to be as stable as cross pinning if they are well spaced at the fracture line, and they are not associated with the risk of iatrogenic ulnar nerve injury.

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

“…The pooled result of iatrogenic ulnar nerve injury in the current study is in agreement with previous reviews [1,3,5,38,40,52]. Babal et al [3] performed a meta-analysis which was derived almost exclusively from retrospective studies and concluded that the medial pin carried the greater overall risk of nerve injury as compared with a lateral-pin-only construct, and that the ulnar nerve was at risk of injury in patients who had medial pins.…”

“…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. Omid et al [40] considered that lateral entry pins could be as stable as crossed pinning in biomechanical and clinical studies if they are well spaced at the fracture line. A systematic review performed by Brauer et al [5] showed that deformity occurred in 3.4% of the patients treated with medial and lateral entry pins and in 5.9% of patients treated with lateral entry pins, therefore concluding that medial and lateral pin entry provides a more stable configuration and the probability of deformity or loss of reduction is 0.58 times lower than with isolated lateral pin entry.…”

Desvios rotacionais na fratura supracondiliana do úmero em crianças: novo método de avaliação

“…O mecanismo de trauma mais comum é a queda com apoio do membro superior e o cotovelo em extensão completa, levando o olécrano a realizar um fulcro posterior na sua fossa, região de maior fragilidade, provocando uma fratura do tipo em extensão, isto é, com desvio posterior (8,9) . Este tipo de desvio representa cerca de 97% a 99% dos casos (5,8) .…”

“…Contudo, desvios rotacionais são mais difí-ceis de serem avaliados. Atribuem-se às más reduções rotacionais a ocorrência do cúbito varo, influenciando a perda da redução, devido à falta de apoio das colunas medial e lateral (9) .…”

“…Dentre estas, as fraturas supracondilianas do úmero são responsáveis por até 50 a 70% dos casos (2)(3)(4) , acometendo principalmente crianças na faixa etária entre cinco e sete anos de idade (5) . As lesões ocorrem predominantemente à esquerda, ou do lado não dominante (5-7) .O mecanismo de trauma mais comum é a queda com apoio do membro superior e o cotovelo em extensão completa, levando o olécrano a realizar um fulcro posterior na sua fossa, região de maior fragilidade, provocando uma fratura do tipo em extensão, isto é, com desvio posterior (8,9) . Este tipo de desvio representa cerca de 97% a 99% dos casos (5,8) .…”