Functional outcome of displaced (gartland type III) supracondylar humerus fractures in children treated by closed reduction and percutaneous kirschner wire fixation: a prospective observational study

Sai Vamshi B.; Bhushan Chickle; Kiran Kumar A. S.

doi:10.18203/issn.2455-4510.IntJResOrthop20263941

Authors

Sai Vamshi B. Department of Orthopaedics, RIMS Raichur, Karnataka, India
Bhushan Chickle Department of Orthopaedics, RIMS Raichur, Karnataka, India
Kiran Kumar A. S. Department of Orthopaedics, BMCRC, Ballari, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263941

Keywords:

Supracondylar humerus fracture, Children, Closed reduction, Percutaneous pinning, Kirschner wire, Flynn’s criteria

Abstract

Background: Displaced (Gartland type III) supracondylar humerus fractures in children risk malunion and neurovascular complications. Closed reduction and percutaneous K-wire fixation is widely regarded as standard treatment, however Indian tertiary-centre data are limited. We evaluated the functional and cosmetic outcomes and complications of this procedure.

Methods: This prospective observational study was conducted at a tertiary care centre, BMCRC Ballari, India; from June 2023 to December 2024, 50 children aged 3–13 years with closed, completely displaced supracondylar fractures underwent closed reduction and percutaneous K-wire fixation under C-arm guidance (crossed pins, n=40; two lateral pins, n=10), then an above-elbow slab application for three weeks. Outcome was graded by Flynn’s criteria.

Results: Mean age was 8.0±2.5 years; 68% were boys and 64% had left-sided injuries. Median time to surgery was 1 day and mean hospital stay 2.6 days. Outcome was excellent in 36 (72%), good in 9 (18%) and fair in 5 (10%); none was poor (satisfactory 100%, 95% CI 92.9–100). Mean loss of motion was 5.4° and of carrying angle 1.9°. Five patients (10%) had complications such as ulnar nerve palsy in 2 (both after crossed pinning; full recovery by two months), K-wire migration in 2 and superficial pin-tract infection in 1. No cubitus varus was recorded.

Conclusions: Closed reduction and percutaneous K-wire fixation gave satisfactory outcomes in all 50 children with few, mostly minor complications. Ulnar nerve injury occurred only after crossed pinning, supporting lateral-entry pinning when adequate stability can be achieved without a medial pin.

References

Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018;3(10):526-40.

Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am. 2008;90(5):1121-32. doi: 10.2106/JBJS.G.01354.

Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109(2):145-54.

Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res. 2015;473(2):738-41.

Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1988;70(5):641-50.

Casiano E. Reduction and fixation by pinning "banderillero" style-fractures of the humerus at the elbow in children. Mil Med. 1960;125(4):262-4.

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

Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in supracondylar fracture of the humerus in children. J Orthop Trauma. 2012;26(1):48-53.

Lee KM, Chung CY, Gwon DK, Sung KH, Kim TW, Choi IH, et al. Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop. 2012;32(2):131-8.

Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001;10(1):63-7.

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

Devkota P, Khan JA, Acharya BM, Pradhan NM, Mainali LP, Singh M, et al. Outcome of supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning. JNMA J Nepal Med Assoc. 2008;47(170):66-70

Tran Trung D, Le Van N, Nguyen Huu V, Dao Nguyen C, Nguyen Ngoc H, Nga VT, et al. Closed reduction and percutaneous pinning for supracondylar fractures of humerus in Vietnamese children. Open Access Maced J Med Sci. 2019;7(24):4194-8.

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

Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004;86(4):702-7.

Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial. J Bone Joint Surg Am. 2007;89(4):706-12.

Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007;27(2):181-6.

Bashyal RK, Chu JY, Schoenecker PL, Dobbs MB, Luhmann SJ, Gordon JE. Complications after pinning of supracondylar distal humerus fractures. J Pediatr Orthop. 2009;29(7):704-8.

Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am. 2007;89(4):713-7.

Gupta N, Kay RM, Leitch K, Femino JD, Tolo VT, Skaggs DL. Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children. J Pediatr Orthop. 2004;24(3):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(4):265-9.

Walmsley PJ, Kelly MB, Robb JE, Annan IH, Porter DE. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br. 2006;88(4):528-30.