The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study

Abstract

We evaluated the clinical and imaging outcomes of loose bone fragments in children with supracondylar humerus fractures after closed reduction with percutaneous pin (CRPP) fixation. A retrospective review was conducted on 12 children with fragments on imaging after closed reduction of displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included fragment outcome, postoperative Baumann angle, carrying angle and loss of reduction. Clinical outcome included the elbow range of motion (ROM), Flynn grade and other complications. Between January 2015 and January 2018, 460 children (2–14 years old) with supracondylar humerus fractures were treated at our center, including 12 (2.6%) with loose bone fragments on postoperative X-ray. Union or absorption of fragments was noted in all 12 patients at 1 year postoperatively, with good radiographic and clinical outcomes. The mean Baumann angle was 15.5° ± 4.3° and the mean carrying angle was 11.2° ± 2.8°. All patients had a normal elbow ROM. Ten patients achieved an excellent and two a good result according to the Flynn criteria. Good results were achieved after CRPP fixation in 12 children with supracondylar humerus fractures and loose bone fragments. The fragments were mainly absorbed or achieved union to the humerus within 1 year.

Lateral Crossed Kirschner Wire combined with External Fixation - An Innovative Surgical Approach for Supracondylar Humeral Fractures in School-Aged Children

“…Supracondylar fractures of the humerus are the most prevalent type of elbow fractures in children 14,15 Traditional external xation, often involving the use of threaded pins greater than 2.0mm in diameter, pose a risk of damaging the distal humeral epiphysis. Given the severe consequences of distal epiphyseal injury, it is crucial to minimize or eliminate the use of such pins in patients with undeveloped epiphyseal plates 20,21 .…”

Value-Driven Pediatric Supracondylar Humerus Fracture Care: Implementing Evidence-Based Practices

“…Loose bone fragments on x-ray are seen in 2.6% of patients and are not an indication for opening because these fragments absorb or reunite eventually. 27 Divergent retrograde oblique pins, at least two for Type II injuries and three for Types III and IV, are ideally placed from the lateral side (Figure 6). Medial pinning carries a 4% risk of iatrogenic ulnar nerve palsy, and although 90% of palsies recover, 28 this is stressful for both families and physicians and can increase the number of visits.…”

“…Loose bone fragments on x-ray are seen in 2.6% of patients and are not an indication for opening because these fragments absorb or reunite eventually. 27…”