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Gartland Type III Supracondylar Fractures in Children; Percutaneous Fixation with Two Kirschner Wires from Lateral Side
Keywords:
Supracondylar fracture, CRPP, Image intensifier.Abstract
Objectives: To determine the outcome of percutaneous stabilization of two Kirschner wires from the lateral side in pediatric supracondylar fracture of the humerus.
Methods: We conducted this study in the Department of orthopedics, Mardan Medical Complex, from 1st January 2021 to 30th December 2021. After ethical committee approval and informed consent from parents, consecutive patients with type III supracondylar fractures were selected for close reduction and percutaneous pinning (CRPP) from the lateral side. A total of 41 patients including 34 male and 7 female were included in the study. Patients in the age group of less than 15 with Gartland type III supracondylar fractures were meeting the inclusion criteria underwent close reduction and percutaneous fixation (CRPF) with k-wires done from the lateral side only under an image intensifier. Open fractures failed close reduction, polytrauma patients, and vascular injury were excluded. Postoperative results were assessed according to Flynn's criteria.
Results: All 41 patients with type III supracondylar fractures were reduced and closely underwent CRPP from the lateral side with a male to female ratio of 4.8:1. Mean age at the time of injury was 7.56 years (range of 4-15). Most of them had an injury on the left side (56.1%) with extension-type fractures being the most common (94.7%). The mechanism of injury was ground-level fall in the majority of cases. Functional results were 70.2% excellent, 19.3 % good, 7.9% fair and 2.6% poor while on the other side cosmetic results were 70.2% excellent, 20.2 % good, 7% fair and 2.6% poor according to the Flynn criteria.
Conclusion: K-wire fixation and removal are easier from the lateral side than from the medial or both medial and lateral with the least chances of ulnar nerve injury. The medial epicondyle wire is close to the ulnar nerve and is at risk for injury during fixation and removal of k.wire. It is an effective method of supracondylar fracture fixation in children. It is an alternative to cross-k wire fixation from both the medial and lateral side.
References
Brubacher JW, Dodds SD. Pediatric supracondylar fractures of the distal humerus. Current reviews in musculoskeletal medicine. 2008;1(3-4):190-6.
Anuar R, Gooi S, Zulkiflee O. The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury. Malaysian orthopaedic journal. 2015;9(3):71.
Leiblein M, Lustenberger T, Schulz A-K, Schmitz-Rixen T, Marzi I. Neurovascular complications after supracondylar humerus fractures in children. Trauma case reports. 2017;8:16-9.
Bhuyan BK. Close reduction and percutaneous pinning in displaced supracondylar humerus fractures in children. Journal of clinical orthopaedics and trauma. 2012;3(2):89-93.
Madjar-Simic I, Talic-Tanovic A, Hadziahmetovic Z, Sarac-Hadzihalilovic A. Radiographic assessment in the treatment of supracondylar humerus fractures in children. Acta Informatica Medica. 2012;20(3):154.
Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Springer; 2015.
Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM. Does the modified Gartland classification clarify decision-making? Journal of Pediatric Orthopaedics. 2018;38(1):22-6.
Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. Journal of Pediatric Orthopaedics. 2012;32(4):346-51.
Urbášek K, Plánka L. Failure of the primary treatment of displaced supracondylar humerus fractures in children. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2014;81(1):57-62.
Eberhardt O, Fernandez F, Ilchmann T, Parsch K. Cross pinning of supracondylar fractures from a lateral approach. Stabilization achieved with safety. Journal of children's orthopaedics. 2007;1(2):127-33.
Shoaib M, Sultan S, Sahibzada SA, Ali A. Percutaneous pinning in displaced supracondylar fracture of humerus in children. Journal of Ayub Medical College Abbottabad. 2004;16(4).
Flynn JC, Matthews JG, Benoit RL. Blind Pinning of Displaced Supracondylar Fractures of the Humerus in Children: SIXTEEN YEARS'EXPERIENCE WITH LONG-TERM FOLLOW-UP. JBJS. 1974;56(2):263-72.
Carvalho RA, Franco Filho N, Castello Neto AB, Reis GD, Dias MP. Supracondylar fracture of the humerus in children: fixation with two crossed Kirschner wires. Revista brasileira de ortopedia. 2012;47(6):705-9.
O'Driscoll SW. Supracondylar fractures of the elbow: open reduction, internal fixation. Hand clinics. 2004;20(4):465-74.
Wingfield JJ, Ho CA, Abzug JM, Ritzman TF, Brighton BK. Open reduction techniques for supracondylar humerus fractures in children. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2015;23(12):e72-e80.
Samal P, Panigrahi T, Biswal S, Sahu MC, Mohan M, Brahma P. Does Late Presentation of Displaced Supracondylar Humerus Fracture in Children Influence Outcomes of Surgery? Journal of Clinical & Diagnostic Research. 2017;11(10).
Bojovi? N, Marjanovi? Z, Živanovi? D, ?or?evi? N, Stojanovi? M, Jankovi? G, et al. SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN. Acta medica Medianae. 2012;51(3).
Salim M, Malik Z, Mallhi EA. Outcome of Close Reduction and Percutaneous Pinning In Displaced Pediatric Supracondylar Fracture of Humerus Assessed By Flynn’s Criteria. Children. 2012 Sep.
Azhar MM. Close Reduction and Percutaneous Pin Fixation in Displaced (Type-III) Supracondylar Fractures of Humerus in Children Surgical Outcomes and Comparison with other study. Injury. 2015 Jan 1;1:1-5.
Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop. 2002 Jul-Aug;22 (4):440-3. PMID: 12131437.).
Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. Journal of Pediatric Orthopaedics. 2007 Mar 1;27(2):181-6.
