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González-Morgado D, Blasco-Casado F, Guerra-Farfán E, de María Prieto JM, Jambrina-Abasolo U, Phillips M, Ekhtiari S, Soldado F. The anterior and medial open approaches yield superior outcomes compared to the lateral and posterior open approaches in supracondylar humerus fractures in children: a systematic review and network meta-analysis. J Pediatr Orthop B 2025; 34:101-111. [PMID: 39229912 DOI: 10.1097/bpb.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
This study aimed to perform a systematic review and network meta-analysis (NMA) to examine which open approach is superior in terms of outcomes and complications in the treatment of pediatric supracondylar humerus fractures. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov , and Cochrane Library were searched from database inception to December 2022 and screened for relevant studies. Data were collected regarding patient demographics, Flynn's functional and cosmetic outcomes, and complications. Unsatisfactory Flynn's and complications were considered negative events. Comparisons of outcomes from aggregate data from each surgical approach using relative risk (RR) with a 95% confidence interval (95% CI) were performed. The NMA of overall negative events was conducted using a Bayesian hierarchical random-effects model analysis. A total of 26 studies involving 1461 patients were included; 459 (31.4%) patients underwent a closed reduction and percutaneous pinning (CRPP), 84 (5.7%) an anterior approach, 240 (16.4%) a medial, 220 (15%) a lateral, and 458 (31.3%) a posterior. The lateral and posterior approaches demonstrate a higher risk of negative event in the NMA compared to CRPP [RR = 2 (1.03, 3.85); RR = 2.63 (1.96, 3.57), respectively], anterior approach [RR = 3.33 (1.11, 10); RR = 4.35 (1.49, 12.5), respectively], and medial approach [RR = 1.82 (1.16, 2.86); RR = 2.38 (1.23, 4.76), respectively]. The medial approach resulted in a similar negative event rate compared to the anterior [RR = 1.82 (0.58, 5.88)]. The anterior and medial open approaches yield superior functional and cosmetic outcomes with fewer complications compared to the lateral and posterior.
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Affiliation(s)
- Diego González-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ferran Blasco-Casado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Unai Jambrina-Abasolo
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mark Phillips
- Health Research Methodology Department, McMaster University, Hamilton, ON, Canada
| | | | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, Barcelona, Spain
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Febyan F, Maharjana MA, Ustriyana NGGN. Closed Reduction and Percutaneous Pinning versus Open Reduction and Internal Fixation in Pediatric Supracondylar Humeral Fractures: A Systematic Review. Rev Bras Ortop 2025; 60:1-8. [PMID: 40276270 PMCID: PMC12020523 DOI: 10.1055/s-0045-1804496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 11/06/2024] [Indexed: 04/26/2025] Open
Abstract
Objective To compare the treatment approaches of closed reduction and percutaneous pinning (CRPP) and open reduction and internal fixation (ORIF) in pediatric supracondylar humeral fractures through a systematic review of cohort and case-control studies. Methods The CRPP and ORIF treatment modalities were evaluated using Flynn's functional criteria and Baumann angle as outcome measures. Results The results support the clinical equivalence of CRPP ORIF regarding functional outcomes. Despite the limited number of studies and the low level of evidence of the included articles, the present study consistently reported no significant differences, which is in line with the overall results. Limited Baumann Angle data prevented conclusive comparisons in this regard. Factors such as length of hospital stay and cosmetic outcomes influence treatment decisions in pediatric supracondylar humerus fractures. A holistic approach is essential, considering clinical efficacy and patient comfort. Future research should expand the evidence base and standardize outcome assessments. Conclusion Both CRPP and ORIF are viable treatments for pediatric supracondylar humerus fractures, particularly those classified as Gartland type III.
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Affiliation(s)
- Febyan Febyan
- Departamento de Ortopedia e Traumatologia, Prof. Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali Surabaya, Indonésia
| | - Made Agus Maharjana
- Departamento de Ortopedia e Traumatologia, Prof. Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali Surabaya, Indonésia
| | - Nyoman Gede Grenata Nanda Ustriyana
- Departamento de Ortopedia e Traumatologia, Prof. Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali Surabaya, Indonésia
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Minifee CD, DeFilippo CG, Carmichael KD. Incidence of complications among operative pediatric supracondylar humerus fractures using medial and lateral pins: a safe technique for percutaneous medial pin placement. J Pediatr Orthop B 2024; 33:585-589. [PMID: 38837079 DOI: 10.1097/bpb.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Cross-pinning of displaced pediatric supracondylar elbow fractures offers a superior stability construct. However, there is a reluctance to use this construct by closed means because of the risk of iatrogenic ulnar nerve injuries associated with percutaneous medial pin placement. This study describes a safe technique for closed reduction percutaneous with medial pin placement. This study reviewed the clinical charts of 232 pediatric patients who underwent closed reduction with cross-pinning of Gartland type II and III supracondylar fractures from 2000 to 2022 at a single institution. All surgeries were performed by the same attending surgeon at the same institution, with the same technique of medial pin placement. The inpatient and outpatient notes were used to record patient demographic information, fracture classification, and postoperative complications. A total of 232 pediatric patients [114 boys, 118 girls; mean age: 5.8 (range: 1-14) years] with Gartland type II ( n = 97) and III (n = 135) supracondylar fractures were included in the study. There were a total of seven (3.02%) postoperative complications: four (1.7%) ulnar neuropathies, two (0.86%) pin site infections, and one (0.43%) anterior interosseous nerve palsy. All documented postoperative complications were resolved by the 3-month follow-up visit. There were no complications of deep infection, malunion, or nonunion. With the proper technique, closed reduction with percutaneous medial pin fixation of pediatric supracondylar fractures is safe and produces excellent postoperative outcomes. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Christopher D Minifee
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch
| | - Christine G DeFilippo
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Kelly D Carmichael
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch
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Zeng T, Wang LG, Liu WQ. Our experience with a modified prying-up technique for closed reduction of irreducible supracondylar humeral fractures. Sci Rep 2024; 14:23048. [PMID: 39367095 PMCID: PMC11452542 DOI: 10.1038/s41598-024-74467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024] Open
Abstract
Satisfactory reduction of some displaced pediatric supracondylar humerus fractures is not achievable via closed reduction, thus necessitating open procedure, which increases the incidence of complications. Using percutaneous prying-up technique to assist closed reduction may reduce the requirement for transform to an open operation. We retrospectively reviewed displaced pediatric supracondylar humerus fractures treated by the same surgeon from September 2021 to January 2024,with 134 subjects meeting criteria for inclusion. These children were divided into two groups. In Group A(n = 61),the prying-up technique was used to assist with closed reduction of fractures. Group B(n = 73) included fractures treated with conventional manual traction. To balance group size,12 fractures from group A were randomly removed, leaving a final 61 patients in each group. Demographics, operative time, the rate of failed closed reduction, complications and radiographic results were analyzed. The operative time was significantly less in Group A as compared with Group B(mean difference, - 7.22; [95% confidence interval (CI), - 8.49 to - 5.94]; p < 0.001). The rate of failed closed reduction were significantly lower in Group A as compared to Group B(2 of 61 vs. 10 of 61, p = 0.015).However, we found no difference in terms of the radiographic results and complications between the two groups(p > 0.05). percutaneous prying-up technique significantly improves the efficiency of surgery and reduces rate of failed closed reduction of supracondylar humeral fractures in pediatric patients. Level III, retrospective comparative study.See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tao Zeng
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3 Kangxin Road, Western District, Zhongshan, 528400, Guangdong, China.
- Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510006, Guangdong, China.
| | - Li-Gang Wang
- Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510006, Guangdong, China
- Shenzhen Pingle Orthopedics Hospital, 252 Shenshan Road, Pingshan District, Shenzhen, 518118, Guangdong, China
| | - Wei-Qi Liu
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, 3 Kangxin Road, Western District, Zhongshan, 528400, Guangdong, China
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González-Morgado D, Blasco-Casado F, Guerra-Farfán E, de María Prieto JM, Jambrina-Abasolo U, Lara-Taranchenko Y, Ekhtiari S, Soldado F. Anterior approach for pediatric supracondylar humerus fractures: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T513-T523. [PMID: 38992464 DOI: 10.1016/j.recot.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE Systematic review of Level 2-4 evidence studies.
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Affiliation(s)
- D González-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - F Blasco-Casado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - E Guerra-Farfán
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J M de María Prieto
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canadá
| | - U Jambrina-Abasolo
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Y Lara-Taranchenko
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canadá
| | - F Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, España
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González-Morgado D, Blasco-Casado F, Guerra-Farfán E, De María Prieto JM, Jambrina-Abasolo U, Lara-Taranchenko Y, Ekhtiari S, Soldado F. Anterior approach for pediatric supracondylar humerus fractures: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:513-523. [PMID: 38852776 DOI: 10.1016/j.recot.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE Systematic review of Level 2-4 evidence studies.
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Affiliation(s)
- D González-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - F Blasco-Casado
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Guerra-Farfán
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M De María Prieto
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - U Jambrina-Abasolo
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Y Lara-Taranchenko
- Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - F Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
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Hahn SG, Schuller A, Pichler L, Hohensteiner A, Sator T, Bamer O, Chocholka B, Jaindl M, Schwendenwein E, Parajuli B, Rapole S, Tiefenboeck T, Payr S. Complications and Outcomes of Surgically Treated Pediatric Supracondylar Humerus Fractures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:791. [PMID: 39062240 PMCID: PMC11276334 DOI: 10.3390/children11070791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
This study describes the outcome of supracondylar humerus fractures in children using crossed K-wires after closed or open reduction with the medial, lateral or bilateral approach. Patients treated between January 2000 and December 2019 were classified according to the Von Laer classification, complications were classified according to the Sink classification and clinical outcomes were classified according to modified Flynn criteria. In total, 364 patients with a mean age of 5.23 ± 2.45 years were included. The majority were type IV fractures (156; 42.9%) and 94 (60.3%) needed an open reduction for which the medial approach (53; 56.4%) was predominantly used. Overall, of 50 complications (31 using closed reduction, 19 open reduction), 17/50 (34%) needed revision surgery. An excellent clinical outcome was achieved in 348/364 (95.6%) patients. The approach used for open reduction as such had no influence on the complication rate or clinical outcome. For severely displaced fractures, the data showed that an open approach for crossed K-wires tended to result in fewer complications and better clinical outcomes than a closed reduction. If an open reduction is indicated, the required approach (medial, lateral or bilateral) should be primarily selected according to the requirements of the fracture pattern and eventual cosmetic considerations.
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Affiliation(s)
- Sebastian G. Hahn
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Andrea Schuller
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Lorenz Pichler
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Anna Hohensteiner
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Thomas Sator
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Oskar Bamer
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Britta Chocholka
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
- Section of Pediatric Trauma Surgery, Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Manuela Jaindl
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
- Section of Pediatric Trauma Surgery, Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Schwendenwein
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
- Section of Pediatric Trauma Surgery, Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Bikash Parajuli
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal;
| | - Sanika Rapole
- Department of Pediatric Orthopedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, India;
| | - Thomas Tiefenboeck
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
| | - Stephan Payr
- Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.H.); (A.S.); (L.P.); (A.H.); (T.S.); (O.B.); (B.C.); (M.J.); (E.S.); (T.T.)
- Section of Pediatric Trauma Surgery, Department of Trauma Surgery, University Clinic of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Albrahim IA, AlOmran AK, Bubshait DA, Tawfeeq Y, Alumran A, Alsayigh J, Abusultan A, Altalib A, Alzaid ZA, Alsubaie SS, Alzahrani MM. Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients: A retrospective study. World J Orthop 2023; 14:791-799. [DOI: 10.5312/wjo.v14.i11.791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Supracondylar humerus fractures account for more than 60% of all elbow fractures and about 1/5 of all pediatric fractures. Unfortunately, these fractures can be associated with risk of complications including neurovascular injuries, malunions and limb deformities. Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.
AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.
METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019. The data extracted included demographic data, fracture characteristics, surgical data, and follow-up outcomes. The collected data was analyzed and P values of < 0.05 were considered statistically significant.
RESULTS Of the cohort, 11% of patients had documented post-operative complications, of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction. While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons, this did not reach statistical significance.
CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures, we found a higher complication rate when surgeries were not performed during working hours. Surgeon level and training had no significant effect on the risk of post-operative complications.
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Affiliation(s)
- Ibrahim A Albrahim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Dalal A Bubshait
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Yaser Tawfeeq
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Jaffar Alsayigh
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar Abusultan
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdulraheem Altalib
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Zaid A Alzaid
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shayma S Alsubaie
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Tomori Y, Nanno M, Majima T. Clinical Results of Closed Reduction and Percutaneous Pinning for Gartland Type II Flexion-Type Supracondylar Humeral Fractures in Children: Report of Three Cases. J NIPPON MED SCH 2023; 90:294-300. [PMID: 37380478 DOI: 10.1272/jnms.jnms.2023_90-402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Supracondylar humerus fractures are the most common upper limb injury in children, but the incidence of flexion-type fractures is relatively low. Herein, we report the clinical results for three children with Gartland type II flexion-type supracondylar humeral fractures treated by closed reduction and percutaneous pinning. From April 2004 to March 2020, 102 children with supracondylar humeral fractures underwent surgery at our hospital and related institutions. Four had a flexion-type supracondylar humeral fracture (3.9%). Three patients (1 boy and 2 girls) with Gartland type II flexion-type supracondylar humeral fractures were followed for more than 12 months. The patients were treated by closed reduction and percutaneous pinning. Age was 7-13 years at the time of injury, and the duration of postoperative follow-up was 12-16 months. In one case, ulnar nerve paresis was observed as a preoperative complication. After performing closed reduction, percutaneous Kirschner wire cross-fixation was performed. Subsequently, long upper limb cast fixation was carried out for 4 weeks postoperatively. One patient developed preoperative nerve paralysis but recovered in approximately 3 months, without postoperative complications such as infection, nerve paralysis, or cubitus varus or valgus deformity. Flynn's criteria results were excellent for two patients and good for one patient. To maintain anatomical reduction of the fracture fragment, closed reduction using a traction table and percutaneous steel wire fixation are useful for treating flexion-type supracondylar humerus fractures in children with Gartland type II fractures.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Mitsuhiko Nanno
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Tokifumi Majima
- Department of Orthopedic Surgery, Nippon Medical School Hospital
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Tarallo L, Novi M, Porcellini G, Schenetti C, Micheloni GM, Maniscalco P, Catani F. Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice? Injury 2022; 53 Suppl 1:S13-S18. [PMID: 33678463 DOI: 10.1016/j.injury.2021.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Type III supracondylar fractures represent a difficult injury to treat and there is no universal consensus regarding the best treatment. The purpose of this study is to assess the incidence of complication associated with open reduction and compare open reduction vs closed reduction, in order to determine which treatment lead to better clinical and radiological outcomes. Is open reduction really associated with a higher number of iatrogenic complication and worse clinical outcomes in comparison to closed reduction? METHODS A total of 55 patients, affected by type III supracondylar humerus fracture, were retrospectively selected and divided into two groups according to which type of treatment they received (open reduction or closed reduction). Major complications correlated with surgical procedure, such as infections, neurovascular iatrogenic lesions, elbow stiffness and painful scarring were assessed. The treatment outcomes and clinical features were compared among the two groups. A statistical analysis to find association between the type of reduction, the restored elbow anatomy and the clinical outcomes were performed. The follow-up varies between 1 year and 7 years. RESULTS No major complications occurred in our series of patients. Excellent and good outcomes were reported among all 26 patients that underwent an open reduction surgery and in 23 out of the 29 patients who received a closed reduction surgery. A higher number of patients in the open reduction group presented angles with normal values; moreover 3 out of the 6 patients with unsatisfactory outcomes presented with angles not in range, underlying the presence of a connection between the restored elbow anatomy and the clinical outcomes. There were no differences among the two groups regarding the presence of complications. DISCUSSION Open reduction should not be considered as a first line option of treatment in any pediatric patient with a type III supracondylar humerus fracture, but in several cases open surgery must be viewed as the choice with the best outcomes not only in presence of neurovascular lesion but also in case of irreducible fracture.
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Affiliation(s)
- Luigi Tarallo
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Michele Novi
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giusepe Porcellini
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Cecilia Schenetti
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gian Mario Micheloni
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Fabio Catani
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Yang L, Yang P, Li L, Tang X. The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study. J Pediatr Orthop B 2022; 31:12-17. [PMID: 33230053 PMCID: PMC8614548 DOI: 10.1097/bpb.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/07/2020] [Indexed: 02/05/2023]
Abstract
We evaluated the clinical and imaging outcomes of loose bone fragments in children with supracondylar humerus fractures after closed reduction with percutaneous pin (CRPP) fixation. A retrospective review was conducted on 12 children with fragments on imaging after closed reduction of displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included fragment outcome, postoperative Baumann angle, carrying angle and loss of reduction. Clinical outcome included the elbow range of motion (ROM), Flynn grade and other complications. Between January 2015 and January 2018, 460 children (2-14 years old) with supracondylar humerus fractures were treated at our center, including 12 (2.6%) with loose bone fragments on postoperative X-ray. Union or absorption of fragments was noted in all 12 patients at 1 year postoperatively, with good radiographic and clinical outcomes. The mean Baumann angle was 15.5° ± 4.3° and the mean carrying angle was 11.2° ± 2.8°. All patients had a normal elbow ROM. Ten patients achieved an excellent and two a good result according to the Flynn criteria. Good results were achieved after CRPP fixation in 12 children with supracondylar humerus fractures and loose bone fragments. The fragments were mainly absorbed or achieved union to the humerus within 1 year.
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Affiliation(s)
- Lei Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Panyi Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Lang Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
| | - Xueyang Tang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China
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12
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Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children. Curr Med Sci 2021; 41:777-781. [PMID: 34403103 DOI: 10.1007/s11596-021-2396-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/03/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow. The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children. METHODS From February 2015 to August 2019, 73 patients with Gartland's type II and III supracondylar fractures were treated with this modified method. Totally, 68 of all patients were followed up for 3-12 months (mean 8.25 months). The evaluation results included fracture nonunion, ulnar nerve injury, pin track infection, carrying angle and elbow joint Flynn score. RESULTS The results showed that bone union was observed in all children, one case had an iatrogenic ulnar nerve injury, and the symptoms were completely relieved in 4 months after removing of the medial-side pin. All children had no cubitus varus deformity and no pin track infection, and the rate of satisfactory results according to Flynn's criteria score was 100%. CONCLUSION The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction, the risk of iatrogenic ulnar nerve injury, and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.
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13
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Li J, Rai S, Tang X, Ze R, Liu R, Hong P. Surgical management of delayed Gartland type III supracondylar humeral fractures in children: A retrospective comparison of radial external fixator and crossed pinning. Medicine (Baltimore) 2020; 99:e19449. [PMID: 32150100 PMCID: PMC7478454 DOI: 10.1097/md.0000000000019449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Xin Tang
- Department of Orthopaedic surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renhao Ze
- Department of Orthopaedic surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Hong
- Department of Orthopaedic surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Su Y, Nan G. Evaluation of A Better Approach for Open Reduction Of Severe Gartland Type III Supracondylar Humeral Fracture. J INVEST SURG 2019; 34:479-485. [DOI: 10.1080/08941939.2019.1649766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yuxi Su
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, The Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxin Nan
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, The Children’s Hospital of Chongqing Medical University, Chongqing, China
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Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures. ACTA ACUST UNITED AC 2019; 55:medicina55080450. [PMID: 31394888 PMCID: PMC6722747 DOI: 10.3390/medicina55080450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Abstract
Background and objectives: Supracondylar humerus fractures are common in children and can be surgically treated. However, the general surgical procedures involving reduction and fixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desired position, prolonged surgery, or chondral damage. This study aimed to show that temporary fixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerus fractures could maintain reduction so that surgical treatment can be easily performed by a single physician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerus fractures who underwent surgical treatment between May 2017 and June 2018 were retrospectively evaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of the forearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pins were applied on the fracture line by first inserting a lateral-entry K-wire and then inserting another K-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nerve tunnel. A tourniquet was not applied in any patient and no patients required open reduction. Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years). The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks, respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia was detected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes were excellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation of the closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration of pinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerus fractures that require surgical treatment with a fabric adhesive bandage may be significantly convenient in practice.
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Korhonen L, Pokka T, Holappa A, Serlo W, Sinikumpu JJ. The Measurement Methods of Movement and Grip Strength in Children with a Previous Upper Extremity Fracture: A Comparative, Prospective Research. Scand J Surg 2019; 109:351-358. [PMID: 31238810 DOI: 10.1177/1457496919857261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Decreased range of motion of the elbow and forearm and decreased grip strength are potential findings following a childhood upper extremity fracture. Clinical follow-up is essential because spontaneous improvement is seen several months after the injury. Freehand measuring with a goniometer and hydraulic dynamometer is used to evaluate clinical result. The new methods are justified in avoiding human typewriting errors, thus improving patient safety. Nevertheless, their feasibility in child patients is unknown. This study aimed to evaluate congruence between the computer-assisted and the free-hand measuring methods. MATERIALS AND METHODS A total of 59 children with a previous supracondylar humerus fracture were clinically examined by means of free-hand (transparent goniometer and hydraulic dynamometer; Jamar, Lafayette Ltd.) and computer-assisted (E-Link System Packages, Biometrics Ltd.) methods. The range of motion and grip strength were measured separately using both methods. Agreement between the measurements was evaluated using the Bland-Altman method. RESULTS The results between the two methods were incongruent and the differences between measurements increased along with the mean of measurements in all categories except elbow extension. Rotational range of motions were smaller and grip strength was weaker while measuring with the computer-assisted method. The mean discrepancy was 0.97° (95% confidence interval = -2.46 to 0.53) for elbow extension and 7.97° (95% confidence interval = 6.60-9.33) for elbow flexion. CONCLUSIONS Grip strength is used to evaluate impairment of hand function. The study method showed slightly lower results in grip strength. Range of motion is essential when evaluating the outcome of supracondylar humerus fracture, while >10° of change in elbow range of motion associate with impaired function. As compared with the gold-standard goniometer, the methods were not congruent. However, all differences were under 10° and probably beyond clinical importance. Because of its advantages in recording the outcomes to electronical charts, the computer-assisted method is recommended option in performing the follow-up of complicated pediatric supracondylar humerus fractures.
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Affiliation(s)
- L Korhonen
- Department of Children and Adolescents, Oulu University Hospital, PEDEGO Research Unit, Oulu University, MRC Oulu
| | - T Pokka
- Department of Children and Adolescents, Oulu University Hospital, PEDEGO Research Unit, Oulu University, MRC Oulu
| | - A Holappa
- Department of Physiatry, Northern Ostrobothnia Hospital District, Oulu, Finland
| | - W Serlo
- Department of Children and Adolescents, Oulu University Hospital, PEDEGO Research Unit, Oulu University, MRC Oulu
| | - J-J Sinikumpu
- Department of Children and Adolescents, Oulu University Hospital, PEDEGO Research Unit, Oulu University, MRC Oulu
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