.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Comparison of Outcome of three Different Approaches for Supracondylar Humerus Fractures in Children.
Keywords:
Flynn’s criteria, Functional outcome, Open reduction, Supracondylar fractures.Abstract
Objectives: To compare the radiological and functional outcomes of lateral, medial and posterior approaches for open reduction and k wire fixation in children with type III supracondylar fractures of the humerus.
Methods: We conducted this retrospective Cohort study in Orthopedic department Dr. Ruth K M Pfau Civil Hospital Karachi. All children with type III supracondylar fracture of the humerus fulfilling the inclusion criteria operated in time period extending from 3rd January 2018 to 3rd December 2020 and with minimum one year follow up were included. The clinical records were reviewed for surgical approaches and children with lateral approach(LA),medial approach(MA) and posterior approach(PA) were asked for follow up visit. Radiological outcome was assessed by measuring Shaft Condylar Angle(SCA) and Baumann angle. Flynn’s criteria was used for functional outcome in all children and results were categorized into Excellent, Good, Fair(satisfactory) and Poor(unsatisfactory). Results of lateral, medial and posterior approach were compared and P value was calculated with Chi-Square test and Kruskal-Wallis test (P value <0.05 significant).
Results: The total number of children in our study were 90. Each LA, MA and PA had 30 children each. Mean age of children in LA was 8.54 ± 4.5 years, MA 7.21 ± 3.5 years and PA 8.1 ± 6.1 years. Mean Shaft Condylar Angle was 42.2±7.1o, 42.5±3.2o and 41.3±2.7o in LA,MA and PA respectively(P> 0.05). Mean Bauman angle was 19.4±4.0o in LA, 20.3±6.3o in MA and 21.6±3.1o in PA (P> 0.05). Excellent outcome was noted in 22(73.33%),17(56.66%) and 15(50%) in LA,MA and PA respectively. ( P> 0.05)Good outcome was noted in 8(26.66%) children in LA, 13(43.33%) in MA and 15(50%) in PA.(P >0.05)
Conclusion: Lateral approach for supracondylar fracture yielded better radiological and functional outcome than medial and posterior approach in our patients. The difference was however not statistically significant.
References
Herring JA, Tachdjian MO. Texas Scottish Rite Hospital for Children. Tachdjian's pediatric orthopaedics 5th ed. Philadelphia: W.B. Saunders; 2013. pp. 1265-86.
Lee HY, Kim SJ. Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique. J Bone Joint Surg Br 2007;89:646-650.
Uludag A, Tosun HB, Aslan TT, Uludag O,Gunay A.Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning. Cureus 2020; 12(6): e8780. doi:10.7759/cureus.8780
Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959;109:145-54.
Timothy B, Shawn E, Albert O. Classifications In Brief: The Gartland Classification of Supracondylar Humerus Fractures. Clin Orthop Relat Res 2015;473:738-41.
Mazzini JP, Martin JR, Esteban MA. Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: a systematic review. J Child Orthop 2010;4(2):143-152.
O'Hara LJ, Barlow JW, Clarke NM. Displaced supracondylar fractures of the humerus in children. Audit changes practice. J Bone Joint Surg Br 2000;82:204-210.
Millis MB, Singer IJ, Hall JE. Supracondylar fracture of the humerus in children. Further experience with a study in Orthopaedic decision-making. Clin Orthop Relat Res 1984;90-97.
Wingfield JJ, Ho CA, Abzug JM, Ritzman TF, Brighton BK. Open Reduction Techniques for Supracondylar Humerus Fractures in Children. J Am Acad Orthop Surg 2015;23:72-80.
Kalenderer O, Reisoglu A, Surer L, Agus H. How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?. Injury 2008; 39:463-466.
Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1998;18:686-690.
Omid R, Choi PD, Skaggs DL.Supracondylar humeral fractures in children. J Bone Jt Surg Am 2008; 90:1121-1132 .
Madjar-Simic I, Talic-Tanovic A, Hadziahmetovic Z, Sarac-Hadzihalilovic A. Radiographic assessment in the treatment of supracondylar humerus fractures in children. Acta Inform Med 202l;20(3):154-159.
Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience in long term follow-up. J Bone Joint Surg Am 1974, 56:263-272.
Hagebusch P, Koch DA, Fau, P, Gramlich Y,Hoffmann R, Klug A. Treatment of grossly dislocated supracondylar humerus fractures after failed closed reduction: A retrospective analysis of different surgical approaches. Arch Orthop Trauma Surg 2021. https://doi.org/10.1007/s00402-021-03937-6
Bamrungthin N. Comparison of Posterior and Lateral Surgical Approach in Management of Type III Supracondylar Fractures of the Humerus among the Children. Med Assoc Thai 2008; 91 (4): 502-506.
K?z?lay YO, Aktekin CN, Ozsoy MH, Aksahin E, Sakaogullar? A, Pepe M, et al. Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should BeUsed After Failed Closed Reduction? J Orthop Trauma 2017;31:18-24.
?ahi E, Zehir S, Sipahioglu S. Comparison of Medial and Posterior Surgical Approaches in Pediatric Supracondylar Humerus Fractures. Niger J Clin Pract 2017;20:1106-11011.
Eren A, Ozkut AT, Altinta? F, Guven M. Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children. Acta Orthop Traumatol Turc 2005;39(3):199-204.
Rokaya PK, Karki DB, Rawal M, Limbu D, Khan JA, Bhandari PR, et al. Medial versus Posterior Triceps Splitting Approach in Open Reduction Internal Fixation of Displaced Supracondylar Fracture of Humerus. J Nepal Health Res Counc 2020;18(1):41-46.
Orfi FA, Ahmad A, Saleem I, Orfi M.Supracondylar humerus fractures; comparison of lateral vs posterior approach in the management of supracondylar humerus fractures in children.Professional Med J 2019;26(04):545-549.
