Management of supracondylar fracture humerus type 3 in children with percutaneous K-wire vs. open reduction and internal fixation with K-wire

Authors

  • Shaik Md Waseem Ahmed Department of Orthopedics, Chalmeda AnandRao Institute of Medical Sciences, Bommakal Village, Karimnagar, Telagana, India
  • R. Biju Department of Orthopedics, Narayana Medical college hospital, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20175659

Keywords:

Supracondylar fracture, Flynn’s criteria, Open reduction, K wire fixation

Abstract

Background: Aim of the study is to determine the relation between the reduction technique percutaneous pinning and open reduction and internal fixation with K-wire used in management of supracondylar humerus fractures in paediatric age group and the ultimate elbow status (functional and cosmetic), so that appropriate reduction technique can be adopted for better functional and cosmetic outcome.

Methods: Children below 12 years with Gartland’s type III supracondylar fractures managed by closed reduction and percutaneous K-wire fixation and open reduction and K-wire fixation and Flynn’s criteria was used to grade the outcome of surgical fixation. 10 Closed reduction and K-wire fixation and 10 open reduction and K-wire fixation were done.

Results: Most of the fractures were sustained when the patient had fallen down on out stretched hand while playing or slip and fall. According to Flynn’s grading, there are 7 excellent, 2 good and 1 fair functional result observed in closed reduction and k wire fixation. There are 4 excellent, 3 good and 3 fair functional results observed in open reduction and k wire fixation with statistically significant p value 0.04.

Conclusions: Open reduction through lateral approach and internal fixation wire K wires is safe and effective method of treatment, if indicated, in supracondylar fractures of humerus in children and is associated with a good outcome. A small incision medially in cases where medial epicondyle cannot be defined to visualize the epicondyle and the ulnar nerve, by which iatrogenic ulnar nerve palsy in percutaneous fixation can be prevented.

References

Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109(2):145-54.

Kocher T. Beitrage zur Kenntniss Einiger Praktisch Wichtiger Fracturformen. Edited by Sallmann C, Basil, 1895.

Topping RE, Blanco JS, Davis TJ. Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop. 1995;15(4):435-9.

Bristow WR. Myositis ossificans and Volkmanns paralysis: notes on two cases, illustrating the rarer complications of supracondylar fracture of the humerus. Br J Surg. 1923;10:475-81.

Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15(1):47-52.

Copley LA, Dormans JP, Davidson RS. Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention. J Pediatr Orthop. 1996;16(1):99-103.

Flynn JC, Mathews JG, benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children: sixteen years experience with long term follow up. J Bone Joint Surg Am. 1974;56:263-72.

Archibeck MJ, Scott SM, Peters CL. Brachialis muscle entrapment in displaced supracondylar humerus fractures: a technique of closed reduction and report of initial results. J Pediatr Orthop. 1997;17(3):298-302.

Peters CL, Scott SM, Stevens PM. Closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children: description of a new closed reduction technique for fractures with brachialis muscle entrapment. J Orthop Trauma. 1995;9(5):430-4.

Cheng JC, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1995;9(6):511-5.

Onwuanyi ON, Nwobi DG. Evaluation of the stability of pin configuration in K-wire fixation of displaced supracondylar fractures in children. Int Surg 1998;83(3):271-4.

Arino VL, Lluch EE, Ramirez AM, et al. Percutaneous fixation of supracondylar fractures of the humerus in children. J Bone Joint Surg (Am). 1977;59(7):914-6.

Skaggs DL, Cluck MW, Mostofi A, et al. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004;86(4):702-7.

Wilkins KE, Beaty J. Fractures in Children. Philadelphia: Lippincott-Raven, 1996.

Culp RW, Osterman AL, Davidson RS et al: Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg. 1990;72:1211-5.

Lyons ST, Quinn M, Stanitski CL. Neurovascular injuries in type III humeral supracondylar fractures in children. Clin Orthop Relat Res. 2000;(376):62-7.

Reitman RD, Waters P, Millis M. Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop. 2001;21:456-9.

Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83(5):735-40.

Reynolds RA, Mirzayan R. A technique to determine proper pin placement of crossed pins in supracondylar fractures of the elbow. J Pediatr Orthop. 2000;20(4):485-9.

Yaokreha JB, Gicquel P, Schneider L, Stanchina C, Karger C, Saliba E, et al. Compared outcomes after percutaneous pinning versus open reduction in paediatric supracondylar elbow fractures. Orthop Traumatol Surg Res. 2012;98:645-51.

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Published

2017-12-22

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Original Research Articles