DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20170080

Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

Nilesh Janardan Keche, Abhijit Bhimrao Kale, Binoti Arun Sheth, Ashok Kumar Rathod

Abstract


Background: Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches.

Methods: In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.

Results: The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3rd and 9th month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2.

Conclusions: Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results.


Keywords


Supracondylar humerus fractures, Closed reduction, Open reduction

Full Text:

PDF

References


Cheng JC, Ng BK, Ying SY, Lam PK. A 10 year study of the changes in the pattern and treatment of 6,493 fractures. J Paediatr orthop. 1999;19(3):344-50.

Dimeglio A. Growth in paediatrics orthopaedics. in: Morrissy RT, Weinsten SL, eds. Lovell and Winters’s paediatrics orthopaedics. 6th edition. philadelphia: Lippincott Williams and wilkins; 2006: 35 -65.

Boyd HB, Altenberg AR. fractures about elbow in childrens. Arch surg. 1944;49:213.

Cheng GC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese childrens. J paediatrics orthopaedics B. 2001;10(1):63-7.

Mahan ST, May CD, Kocher MS. operative management of displaced flexion supracondylar humerus fractures in children. J Paediatr Orthop. 2007;27(5):551-6.

Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Paediatr Orthop. 1998;18(1):38-42.

Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in the childrens: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001;6:312–5.

Topping RE, Blanco JS, Davis TJ. Clinical evaluation of crossed pin versus lateral pin fixation in displaced supracondylar humerus fracture. J Paediatr Orthop. 1995;15(4):435-9.

Rowell PJW. Arterial occlusion in juvenile humeral supracondylar humeral fractures. Injury. 1974;6:254-6.

Hammond G. The management of S.C. fractures of the humerus in children. Surgical Clinics of N.A. 1952;32(2):747.

Dinielsson L, Pettersson H. Open reduction and pin fixation of severely displaced S.C. fractures of the humerus in children. Acta Orthop Scand. 1980;54:249.

Kasser JR, Beaty JH. Supracondylar fractures of the distal humerus. Chapter14. In: Rockwood and Wilkins Fractures in Children. 6th edition. Philadelphia: Lippincott Williams and Wilkins; 2006: 543-589.

Aslan A, Konya MN, Özdemir 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 Trauma Limb Reconstr. 2014;9(2):79–88.

Yousri T, Tarassoli P, Whitehouse M, Monsell F, Khan WS. Systematic review of randomized controlled trials comparing efficacy of crossed versus lateral K-wire fixation in extension type Gartland type III supracondylar fractures of the humerus in children. Ortop Traumatol Rehabil. 2012;14(5):397–405.

Pretell-Mazzini J, Rodriguez-Martin J, Auñon-Martin I, Zafra-Jimenez JA. Controversial topics in the management of displaced supracondylar humerus fractures in children. Strategies Trauma Limb Reconstr. 2011;6:43–50.

Mazda K, Boggione C, Fitoussi F, Penneçot GF. Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children. A prospective study of 116 consecutive patients. J Bone Joint Surg. 2001;83:888–93.

Mehserle WL, Meehan PL. Treatment of the displaced supracondylar fracture of the humerus (Type 3) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop. 1991;11:705–11.

Sharma A, Walia JPS, Brar BS, Sethi S. Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning. Indian J Orthop. 2015;49(5):529-35.

Kaewpornsawan K. Comparison between closed reduction with percutaneous pinning and open reduction with pinning in chidrens with closed totally displaced supracondylar humeral fractures: a randomised controlled trial. J Paediatr Orthop. 2001;(10):131–7.

Aronson DD, Prager BI. Supracondylar fractures of the humerus in children. Clin Orthop Relat Res. 1987;219:174–84.

Ozkoc G, Gonc U, Kayaalp A, Teker K, Peker TT. Displaced supracondylar humeral fractures in childrens: open reduction vs. closed reduction and pinning. Arch Orthop Trauma Surg. 2004;124:547–51.

Yadav UB, Singhal R, Tonk G, Aggarwal T, Verma AN. Crossed pin fixation in displaced supracondylar humerus fractures in children. Traumatol. 2004;38:166-9.

Sial NA, Yasin A, Rashid A. Supracondylar humerus fractures outcome of open reduction and percutaneous crossed pin fixation. Prof Med J. 2011;18(1):147-53.

Mehserle WL, Meehan PL. Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop. 1991;11(6):705-11.