Paratricepital approach for open reduction and internal fixation of delayed presentation of pediatric supracondylar humerus fracture
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20195802Keywords:
Supracondylar, Humerus, Fracture, Pediatric, Paratricepital approachAbstract
Background: Delayed presentation of pediatric displaced supracondylar humerus fracture is relatively common. Management of such cases have higher incidence of perioperative complications and usually require open reduction and pinning. Open reduction can be done by various approaches, each having its own advantage and disadvantages.
Methods: A prospective study was done comprising 20 children with displaced Supracondylar fracture presented 2-14 days of injury, Mean patient age was 6 years. 15 were boys and 5 were girls. Children in whom closed reduction and percutaneous pinning was achieved, vascular injury and more than 2 weeks old fracture cases were excluded. Paratricepital approach was used for Open reduction and pinning for all the cases. The functional outcome was assessed using Flynn criteria.
Results: In all cases the fracture had united at complete follow-up and the mean follow-up period was 16 months. The outcome was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%), and poor in 1 (5%) patients. The mean Baumann angle was 76º in the affected elbow and 73º in the normal elbow. Average time for complete union in the current study was 7 weeks. Pin tract infection was seen in 2, stiffness in 2 patients, cubitus varus in 1 patient. No case of compartment syndrome or iatrogenic nerve injury was seen was recorded.
Conclusions: Finally, we concluded that triceps sparing paratricepital approach is an easy, simple and safe approach for exposure and internal fixation of supracondylar humeral fractures in children with excellent functional outcome.
References
Loizou CL, Simillis C, Hutchinson JR. A systematic review of early versus delayed treatment for supracondylar humeral fractures in children. Injury. 2009;40:245-8.
Yildirim AO, Unal VS, Oken OF, Gulcek M, Ozsular M, Ucaner A. Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients. J Child Orthop. 2009;3:265-9.
Leet AI, Frisancho J, Ebramzadeh E. Delayed treatment of type-3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002;22:203-7.
Shakir H, Malik FA, Khalid W. Displaced supracondylar fractures of humerus in children treated with open reduction and cross k-wire fixation. JPMI. 2010;24:301-6.
Alonso-Lames M. Bilaterotricipital approach to elbow. Its application in the osteosynthesis of supracondylar fractures in the humerus in children. Acta Orthop Scand. 1972;43(6):479-90.
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;56:263-72.
Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg. 2001;83:323-7.
Abdullah E, Melih G, Bulent E, Murat C. Delayed surgical treatment of supracondylar humerus fractures in children using a medial approach. J Child Orthop. 2008;2:21-7.
Bamrungthin N. Comparison of posterior and lateral surgical approach in management of type III supracondylar fractures of the humerus among the children. J Med Assoc Thai. 2008;91:502-6.
Tiwari A, Kanojia RK, Kapoor SK. Surgical management for late presentation of supracondylar humeral fracture in children. J Orthop Surg. 2007;15(2):177-82.
Lal GM, Bhan S. Delayed open reduction for supracondylar fractures of the humerus. Int Orthop. 1991;15(3):189-91.
Rizk AS. Triceps sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children. J Orthop Traumatol. 2015;16(2):105-16.
Mazzini JP, Martin JR, Esteban EMA. Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: a systematic review. J Child Orthop. 2010;4:143-52.
Bulut G, Sarıoğlu E, Mık G, Ofluoğlu Ö, Bekler Hİ. Posterior bilaterotricipital approach for surgical treatment of children’s Gartland Type III supracondylar humeral fractures. European J Orthop Surg Traumatol. 2012;22(6):457-65.
Erpelding JM, Adam M, Robin H, Matthew MA, Edward FV. Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach. J Bone Joint Surg Am. 2012;94:548-53.
