Comparative study of closed reduction vs. open reduction fixed with k-wiring in type 3 displaced supracondylar fractures in children
Keywords:Type 3C supracondylar fractures, K-wiring, Closed reduction, Triceps splitting, Open reduction
Background: Among all the fractures in upper limb in children, supracondylar fractures of the humerus are more common injuries. In general the fractures of children are treated conservatively. But the management of supracondylar fractures has evolved over years from conservative to more aggressive approach operative techniques.
Methods: The study was conducted in children's presenting with type 3 Gartland supracondylar fractures to Adichunchanagiri Institute of Medical Sciences, B. G. Nagara between January 2014 to December 2016.
Results: The study consisted of 40 type 3 supracondylar fractures cases. Group A (closed reduction) had 25 cases, among them were 20 males and 5 were females. Group B (open reduction) had 15 cases among them 12 males and 3 female cases. The patients were between the age of 6 to12 years. In Group A, 19 children were in the age group of 6-10 years where as Group B had 12 cases. In Group A, 6 were in the age group of 10-12 years and 3 cases in Group B. Among the 25 cases in Group A, 19 were left sided and 6 were right sided. In group B, 11 were left sided and 4 were right sided. All patients had achieved clinical and radiological union at 4 weeks.
Conclusions: Closed reduction and k-wiring had very good results for type 3 supracondylar fractures of humerus in children than conservative/open reduction methods. However for cases which we didn't get proper/satisfactory reduction in closed method, open method with triceps splitting approach was used.
Mazda K, Boggione C, Fitoussi, GF. Penneçot Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children J Bone Joint Surg. 2001;83:888-93.
Ambrosia RD. Supracondylar fractures of humerus – prevention of cubitus varus. J Bone J Surg Am. 1972;54:60–6 .
Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fracture of the humerus in children. Sixteen years' experience with long-term follow-up. J Boint J Surg Am. 1974;56:263–72.
Otsuka NY, Kasser JR. Supra condylar fractures of the humerus in children. J Am Acad Orthop Surg 1997;5(1):19–26.
Rijal KP, Pandey BK. Supracondylar extension type III fracture of the humerus in children: Percutaneous cross – pinning. Kathmandu University Med J. 2006;4(4):465–9.
Sibinski M, Sharma H, Bennet GC. Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in childrenJ Bone Joint Surg [Br]. 2006;88:380-1.
Walmsley P, Kelly MB, Robb JE, Annan IH. Porter Delay increases the need for open reduction of type-III supracondylar fractures of the humerus J Bone Joint Surg [Br]. 2006;88:528-30.
Devkota P, Khan JA, Acharya BM, Pradhan NMS, Mainali LP, Singh M, et al. Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning. J Nepal Med Assoc. 2008;47(170):66–70.
Lewis EZ, Christopher JW, Nahid M, Charalampos Z. Time of Return of Elbow Motion after Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures ,Clin Orthop Relat Res. 2009;467(8):2007–10.
Haque MR, Haque AM, Hamid F, Hossain MD. Displaced Supracondylar Fractures of the Humerus in Children: Treatment by Open Reduction and Internal Fixation by Two Crossed Kirschner Wires. Dinajpur Med Col J. 2010;3(1):25–8.
Sanglim L, Moon SP, Chin YC, Dae GK, Ki HS, Tae WK. Consensus and Different Perspectives on Treatment of Supracondylar Fractures of the Humerus in Children. Clin Orthop Surg. 2012;4(1):91-7.