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Treatment of Paediatric Supracondylar Fractures of the Humerus: Closed or Open?
Keywords:
Fracture, Humerus, Closed reduction, K wireAbstract
Objective: To compare the functional outcome of paediatric supracondylar fractures of the humerus treated with closed reduction and percutaneous(CRP) K wire fixation versus open reduction(OR) and K wire fixation.
Methods: The design of our study was retrospective Cohort and was conducted in Department of Orthopaedics Civil Hospital Karachi. The medical record of all the children who were operated in the time period of 8th March 2019 to 07th September 2020 for type III distal humerus fractures were reviewed. All the children fulfilling the inclusion criteria were called for follow up. Patients were divided into group A(CRP crossed K wire fixation) and group B(OR crossed K wire fixation through posterior midline incision with triceps sparing approach). Functional outcome in both groups was evaluated with Flynn’s criteria and graded as Excellent, Good, Fair(satisfactory) and Poor(unsatisfactory).The results of both group A and B were compared and statistical significance documented by calculating P value with Chi-Square test(P <0.05 significant).
Results: The total number of children were 60 and divided equally into Group A(n=30) and Group B(n=30).The mean age of group A was 6±1.1 years and group B 6.9 ± 3.83 years. Male children were 21(70%) in Group A and 18(60%) in group B while female children were 9(30%) and 12(40%) in Group A and Group B respectively.in Group A children results were excellent in
21(70%) and good in 9(30% ) children. In group B excellent results were noted in 9(30% ),good in 08(26.6%), fair in 6(20%) and poor in 7(23.3% )children. The difference among the excellent, fair and poor outcome of the two groups was found significant( P Value < 0.05)
Conclusion: CRP K wire fixation of supracondylar fractures of the humerus was better than OR K wire fixation because it yielded excellent and good outcome in most patients
References
Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001; 10(1):63-67.
Parsa A, Esmaeili B, Hallaj Moghaddam M, Omidi Kashani F, Dadgar Moghaddam M, Rezaeian A. Closed Reduction versus Open Reduction and Pin Fixation in Pediatric Type III Supracondylar Humeral Fractures. Int J Pediatr 2020; 8(7): 11609-615.
Chen RS, Liu CB, Lin XS, Feng XM, Zhu JM .Supracondylar extension fracture of humerus in children: manipulative reduction, immobilisation and fixation using a U-shaped plaster slab with the elbow in full extension. J Bone Joint Surg [Br] 2001;83-B:883-7.
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;17:298–302.
Aronson DC, van Vollenhoven E, Meeuwis JD. K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment. Injury 1993;24:179–81.
Cramer KE, Devito DP, Green NE. Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. Journal of orthopaedic trauma. 1992; 6(4):407-12.
Lewine E, Kim JM, Miller PE, Waters PM, Mahan ST, Snyder B, et al. Closed versus open supracondylar fractures of the humerus in children: a comparison of clinical and radiographic presentation and results. Journal of Pediatric Orthopaedics. 2018; 38(2):77-81.
Aslan A, Konya MN, Ozdemir A, Yorgancigil H, Maralcan G, Uysal E. Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children. Strategies in Trauma and Limb Reconstruction. 2014; 9(2):79-88.
Hussein al-Algawy AA, Aliakbar AH, Witwit HN. Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children. Eur J Orthop Surg Traumatol 2019;29, 397–403.
Houshian S, Mehdi B, Larsen MS.The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 2001; 6:312–315.
Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gyn Obstet 1959; 109:145-154.
Flynn JC, Matthews JG, Benoit RL.Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg.1974;56:263-272.
Shrestha AK, Uprety S, Govinda KC, Paudel S. Functional and radiological outcome after closed reduction and percutaneous pinning versus open reduction and internal fixation in displaced supracondylar fractures in children. JSSN 2016; 19 (2):21-27.
Ozkoc, G, Gonc U, Kayaalp A, Teker K, Peker TT. Displaced supracondylar humeral fractures in children: open reduction vs. closed reduction and pinning. Arch Orthop Trauma Surg 2004; 124, 547–551.
Keskin D, Sen H. The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning. Acta Chir Orthop Traumatol Cech 2014;81(6):380-6.
Kaewpornsawan K. Comparison between closed reduction with percutaneous pinning and open reduction with pinning in children with closed totally displaced supracondylar humeral fractures: a randomized controlled trial. J Ped Orthop. Part B. 2001;10(2):131-137.
Rakha A, Khan DA, Arshad A, Khan ZA, Ahmad S, Mahmood S.Comparison of Efficacy Between Open and Close Reduction in Supracondylar Fracture of Humerus in Children using Flynn's Criteria. Annals Punjab Med Coll 2020;14(1):32-6.
Talib A, Niaz MA, Sultan Y, Furqan A Supracondylar Fracture; Comparison Of Outcomes Of Open Versus Closed Percutaneous K-Ware Fixation In Displaced Supracondylar Fracture. Professional Med J.2017;24(7):997-1001.
Yaokreh 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 Oct;98(6):645-51.
Roessingh AS, Reinberg O. Open or closed pinning for distal humerus fractures in children? Swiss Surg 2003;9(2):76-81.
Lin-Guo, Zhang XN, Yang JP, Wang Z, Qi Y, Shan-Zhu, et al. A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children. J Orthop Surg Res.2018; 13:141-151.
