DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20171461

Closed pinning for paediatric supracondylar fractures: does timing really matter?

Suresh Babu Surapaneni, Ravi Kiran Kopuri, Venkata Suresh Babu Tummala

Abstract


Background: Management guidelines and comparative studies are not yet clear for those patients who present early and late with widely displaced supracondyle humerus fracture in children.

Methods: A total of 74 children were included in this study, 30 patients presenting early within 24 hours as group 1, and 44 patients who presented late i.e. after 24 hours and within a week as group 2 underwent closed reduction and pinning.

Results: In group one 24 had excellent, 6 had good results, according to modified Flynn’s criteria. One patient developed ulnar nerve palsy which was iatrogenic, and improved completely after wire removal. Another was brachial artery injury which was explored and recovered completely. In group 2 the average delay in presentation was 57.56 hours; mean time to surgery after presentation was 9.83 hours. Sixteen patients (36.36%) had neurologic complications at presentation to the emergency room of which three had median nerve palsy (6.81%) whereas seven (15.90%) had isolated anterior interosseous nerve palsy and six (13.6%) had radial nerve palsy all patients showed total neurological recovery at 12 weeks. Six patients (13.63%) had vascular compromise at initial presentation of which five patients had feeble radial pulse and one had absent radial pulse, but capillary filling was adequate in all. The pulse was restored within 24 hours in all patients following reduction. There were 37 excellent, 6 good and 1fair results.

Conclusions: Our results support, closed reduction and Percutaneous pin fixation as an effective treatment option for grossly displaced supracondylar fractures presenting early and late but requires good and careful judgment and also technique.


Keywords


Timing of surgery, Paediatric supracondyle humerus fracture

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References


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

Agarwal A, Agarwal R. The Practice and Tradition of Bonesetting. Education for Health. 2010;23(1):1-8.

Ismatullah, Khan LA. Results of conservative treatment of displaced extension type supracondylar fractures of humerus in children. JPMI. 2009;23(1):95-8

Aman D, Kiran KE, Rajesh M, Sharma L, Mallinath G. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation. Chinese J Traumatol. 2011;14(1):14-9.

Sadiq MZ, Syed T, Travlos J. Management of grade-III supracondylar fracture of the humerus by straight-arm lateral traction. Intern Orthop (Sicot). 2007;31:155–8.

Campbell CC, Waters PM, EmansJB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15:47–52.

Sabharwal S, Tredwell SJ, Beauchamp RD, Mackenzie WG, Jakubec DM, Cairns R, et al. Management of pulseless pink hand in pediatric supracondylar fractures of humerus. J Pediatr Orthop. 1997;17:303-10.

Erasmus JF. Post-traumatic arterial spasm – A report of 17 cases. S Afr Med J. 947;21(21):806-20.

Ating’a JE. Conservative management of supracondylar fractures of the humerus in Eastern Provincial General Hospital, Machakos. East Afr Med J. 1984; 61:557–60.

France J, Strong M. Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction and percutaneous pinning. J Pediatr Orthop. 1992;12:494-8.

Cheng JC, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1995;9:511–5.

Topping RE, Blanco JS, Davis TJ. Clinical evaluation of crossed pin versus lateral pin fixation of the displaced supracondylar humeral fracture. J Pediatr Orthop. 1995;15:435-9.

Tiwari A, Kanojia RK, Kapoor SK. Surgical management for late presentation of supracondylar humeral fracture in children. J Orthopaed Surg. 2007;15(2):177-82.

Archibeck MJ, Scott SM, Peters CL. Brachialis muscle entrapment in displaced supracondylar humerus fractures: a techniqueof closed reduction and report of initial results. J Pediatr Orthop. 1997;17(3):298-302.

Boyd DW, Aronson DD. Supracondylar fractures of the humerus: a prospective study of percutaneous pinning. J Pediatr Orthop. 1992;12(6):789-94.

Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1998;18(5):686-90.

Jones KG. Percutaneous pin fixation of fractures of the lower end of the humerus. Clin Orthop Relat Res. 1967;50:53-69.

Leet AI, Frisancho J, EbramzadehE.Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002;22(2):203-7.

Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children: sixteen years' experience with long-termfollow-up. J Bone Joint Surg Am. 1974;56(2):263-72.

Green DW, Widmann RF, Frank JS, Gardner MJ. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma. 2005;19(3):158-63.