What is the best fixation technique for the treatment of supracondylar humerus fractures in children?

Patriota, Gyoguevara; Filho, Carlos Alberto Assunção; Assunção, Carlos Alberto Almeida de

doi:10.1016/j.rboe.2017.05.013

Cited by 17 publications

(24 citation statements)

References 23 publications

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“…The most commonly reported post‐operative outcomes were loss of Baumann and carrying angle. Neither were found to have statistically significant differences between both treatment groups, in agreement with previous meta‐analyses results 4–6 . Meta‐analyses have previously investigated functional outcome using Flynn criteria, a grading system incorporating both loss of carrying angle and elbow range of motion as listed in Table 4 23 .…”

Section: Discussionsupporting

confidence: 84%

“…Majority of iatrogenic ulnar nerve injuries are directly associated with medial wire insertion in cross pinning, making treatment‐based analysis of this outcome more appropriate. A higher rate of iatrogenic ulnar nerve injury in cross pinning was also found by other meta‐analyses 3–8,21 . Cause of injury is multifactorial, including blocking of usual anterior nerve translation, direct penetration and stretching around the medial pin 5,22 .…”

Section: Discussionmentioning

confidence: 60%

“…Use of a mini‐open technique, where an incision is made to safeguard the ulnar nerve prior to pin insertion, is thought to be associated with a lower rate of injury 22 . Unlike Patriota et al ., 4 no statistically significant difference was found in iatrogenic ulnar nerve injury when adopting a mini‐open technique with both intention‐to‐treat and treatment‐based analyses. This may be due to only three studies being eligible to be included in this subgroup analysis, making it inadequately powered to find a significant difference.…”

Section: Discussionmentioning

confidence: 93%

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Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Kwok

Clayworth

Nara

2021

ANZ Journal of Surgery

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Background Supracondylar humerus fractures are common in children. Percutaneous pinning remains the mainstay in treatment; however, there is lack of consensus on the optimal configuration: lateral‐only pinning or cross pinning. This study aims to investigate the differences in clinical and surgical outcomes between lateral‐only and cross‐pinning paediatric supracondylar humerus fractures. Methods A systematic search was performed using Medline Ovid, Embase and Cochrane databases for relevant randomized control trials comparing lateral and cross pinning of paediatric supracondylar humerus fractures, reporting at least one of the following: rate of iatrogenic ulnar nerve injury, loss of reduction, infection, loss of Baumann's angle and loss of carrying angle. Statistical analysis was performed using STATA 13.0. Results Eleven suitable randomized control trials involving 900 patients were reviewed. Loss of reduction was more common with lateral pinning (relative risk 1.44, 95% confidence interval 1.04–2.00, P = 0.027). Iatrogenic ulnar nerve injury was less common in lateral pinning with treatment‐based analysis (relative risk 0.36, 95% confidence interval 0.14–0.92, P = 0.032). There was no statistically significant difference in loss of carrying angle, loss of Baumann angle or rate of infection. Conclusion Cross pinning provides superior stability in the treatment of supracondylar humerus fractures in children; however, it carries greater risk of iatrogenic ulnar nerve injury.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

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Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Kwok

Clayworth

Nara

2021

ANZ Journal of Surgery

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“…The incidence of supracondylar humeral fractures in children has increased by 28% in the past decade [ 5 ], while the surgical rate has also increased [ 6 ]. There are several surgical techniques including K-wire, corticoid screw, and elastic intramedullary nail [ 7 , 8 ]; however, the standard surgical treatment for displaced pediatric supracondylar humeral fractures is closed reduction and percutaneous pinning (CRPP), with the placement of a postoperative plaster cast [ 9 , 10 ]. The elbow joint movement can be restricted to varying degrees after the removal of the plaster cast.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents

Wang

Zhao

et al. 2021

J Orthop Surg Res

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Objective To evaluate the efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents. Methods We retrospectively analyzed clinical data from 49 older children (> 8 years) and adolescents with supracondylar humerus fracture who were treated with Slongo’s external fixation in our hospital from January 2016 to August 2020. Twenty-three patients received ultra-early postoperative rehabilitation (rehabilitation group) and 26 patients were not subjected to postoperative rehabilitation (control group). Time to ROM required for functional activity of daily living(ROM-ADL) in both groups was recorded postoperatively. Patients were followed up at 3 and 6 months after surgery to compare the elbow range of motion (ROM) and carrying angle (CA). Postoperative complications were assessed in both groups. Flynn scores and modified Mayo Elbow Performance Scores were also performed. Results The elbow function at 6 months after surgery was significantly better than that at 3 months in the control group (P = 0.32). Time to ROM-ADL in the rehabilitation group was significantly shorter than that of the control group (P = 0.028). The elbow function, Flynn scores, and modified Mayo scores in the rehabilitation group at 3 and 6 months after surgery were significantly better than that of the control group (P(ROM, 3 months and 6 months) = 0.012 vs 0.039; P(Flynn scores, ROM, 3 months and 6 months) = 0.028 vs 0.005; P(Flynn scores, CA, 3 months and 6 months) = 0.032 vs 0.026; P(Modified Mayo scores, 3 months and 6 months) = 0.039 vs 0.024; respectively). There were no iatrogenic injuries, secondary fracture displacements, myositis ossificans, elbow deformities, or other complications in either group. One case of nail tract infection occurred in the rehabilitation group and was cured. Conclusion Slongo’s external fixation is a safe and effective surgical treatment for supracondylar humeral fractures in children over 8 years old and adolescents. Ultra-early rehabilitation treatment for postoperative children can significantly speed up the recovery after surgery.

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“…The occurrence of supracondylar fracture of the humerus account for 55 to 75% of patients with elbow fractures [ 3 , 4 ]. For treatment of this fracture, closed reduction and percutaneous pinning, and open reduction and internal fixation were two common managements for supracondylar fracture of the humerus [ 5 ]. Ducic et al [ 6 ] revealed that closed reduction and percutaneous pinning was associated with an increase of the clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

et al. 2018

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BackgroundThe objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children.MethodsIn January 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for two different managements for supracondylar humeral fractures in children were retrieved. The primary endpoint was the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSix clinical studies with 581 patients were ultimately included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous cross-pinning, and open reduction and internal fixation in terms of the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection (P > 0.05).ConclusionsClosed reduction and percutaneous pinning, and open reduction and internal fixation of supracondylar humeral fractures in children result in similar construct stability and functional outcome. More high quality randomized controlled trials are needed to identify this conclusion.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0806-1) contains supplementary material, which is available to authorized users.

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What is the best fixation technique for the treatment of supracondylar humerus fractures in children?

Cited by 17 publications

References 23 publications

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents

A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

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