The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update

Our experience with a modified prying-up technique for closed reduction of irreducible supracondylar humeral fractures

Satisfactory reduction of some displaced pediatric supracondylar humerus fractures is not achievable via closed reduction, thus necessitating open procedure, which increases the incidence of complications. Using percutaneous prying-up technique to assist closed reduction may reduce the requirement for transform to an open operation. We retrospectively reviewed displaced pediatric supracondylar humerus fractures treated by the same surgeon from September 2021 to January 2024,with 134 subjects meeting criteria for inclusion. These children were divided into two groups. In Group A(n = 61),the prying-up technique was used to assist with closed reduction of fractures. Group B(n = 73) included fractures treated with conventional manual traction. To balance group size,12 fractures from group A were randomly removed, leaving a final 61 patients in each group. Demographics, operative time, the rate of failed closed reduction, complications and radiographic results were analyzed. The operative time was significantly less in Group A as compared with Group B(mean difference, - 7.22; [95% confidence interval (CI), - 8.49 to - 5.94]; p < 0.001). The rate of failed closed reduction were significantly lower in Group A as compared to Group B(2 of 61 vs. 10 of 61, p = 0.015).However, we found no difference in terms of the radiographic results and complications between the two groups(p > 0.05). percutaneous prying-up technique significantly improves the efficiency of surgery and reduces rate of failed closed reduction of supracondylar humeral fractures in pediatric patients. Level III, retrospective comparative study.See Guidelines for Authors for a complete description of levels of evidence.

Epidemiological characteristics and distribution of pediatric supracondylar fractures in South China: a retrospective analysis of 760 cases

To evaluate demographic characteristics and distribution of pediatric supracondylar fractures (SCFs) at a tertiary hospital in South China. A retrospective observational study was conducted on children aged 15 years or younger with a diagnosis of SCFs during the period from January 2016 to December 2018. Patients' medical records and radiographs were retrospectively analyzed for age at the time of injury, sex, site and mechanism of traumatic injury. A total of 760 patients with 761 SCFs were reviewed (453 males, 59.6%, and 307 females, 40.4%). There were 748 extension-type fractures (98.3%) and 13 flexion-type fractures (1.7%). Associated injuries were identified in 30/760 (3.9%) patients: associated fracture ( n  = 15; 2%), nerve injury ( n  = 12; 1.6%), open fracture ( n  = 2; 0.2%) and compartment syndrome ( n  = 1; 0.1%). Age at the time of fracture has a bimodal pattern with a first peak around the age of 1 year and a second peak around the age of 4-5 years. The fractures occurred mostly around 11 a.m. and between 4 and 9 p.m. in the evening. Most fractures occurred at home (50.7%), and falling down (62.2%) was the most frequent mechanism of injury. SCFs occurred most frequently in children aged 1 and 4-5 years, and during daylight hours. In about 96% of cases, these were isolated injuries, and falling down was found to be the most frequent traumatic mechanism. Based on our findings, targeted educational efforts and interventions can be set up in order to prevent the occurrence of SCFs in South China. Level of evidence: III.

Minimally invasive technique combined with external fixator in the treatment of pediatric flexion-type humeral supracondylar fractures

Flexion-type pediatric humeral supracondylar fractures are rare, and the reduction technique remains contradictory. A minimally invasive technique using percutaneous leverage reduction combined with an external fixator was described to achieve satisfactory reduction and avoid the open reduction in this study. The operation and clinical results of patients treated with this technique were retrospectively compared with traditional closed reduction. From January 2013 to January 2018, children diagnosed with displaced flexion-type humeral supracondylar fractures were included in this study. Patients were treated with closed reduction (Group A) or minimally invasive reduction technique (Group B). The external fixator fixation was then applied. The demographic information, as well as the clinical and functional results of the operation, were retrospectively reviewed and evaluated. There were twenty-two patients, ten in Group A and twelve in Group B. The mean duration of the operation in Group A was more prolonged than Group B (59 min versus 46 min, p < 0.001). No infection, nonunion, myositis ossificans, neurovascular injury or other complications related to the operation were observed by the time the fractures healed. During an average 36 months follow-up time, almost all children achieved good to excellent results except for one fair in Group A according to the MEPS and the Flynn criteria. This study introduced a safe and efficient minimally invasive technique for displaced flexion-type supracondylar humerus fractures. With the assistance of mosquito forceps, this leverage technique might achieve similar satisfactory clinical outcomes as traditional closed reduction but with a shorter surgical duration.

How Kirschner Wires Crossing Each Other at the Fracture Site Affect Radiological and Clinical Results in Children With Gartland Type 3 Supracondylar Humerus Fractures?

Background In this study, we compared two groups of children with Gartland Type 3 supracondylar humerus fractures with respect to the crossing point of Kirschner wires (K-wires) in terms of radiological and clinical results after closed reduction and fixation with the crossed-pin technique. We hypothesized that even if medial and lateral pins cross each other at the fracture line, satisfactory radiological and clinical results would be achieved with the crossed-pin technique. Methodology A total of 59 patients with Gartland extension Type 3 supracondylar humerus fractures who underwent closed reduction and percutaneous crossed-pin fixation were included in the study. K-wires were crossing each other proximal to the fracture site in the proximal crossing group and at the fracture level in the fracture site crossing group. Loss of reduction, Baumann angle, shaft condyle angle, range of motion, and carrying angle were compared between the two groups. Results There were 43 males and 16 females in this study, with a mean age of 5.3±2.4 years. The average follow-up duration was 21.9 ± 5.2 weeks. In terms of loss of reduction in the coronal and sagittal planes, there was no statistical difference between the two groups. When the Baumann angle and shaft condylar angle of both groups were analyzed, no statistically significant differences were found at both early postoperative examination and final follow-up. Conclusions Although the crossing point of K-wires has been shown to be an important factor in the protection of reduction in biomechanical studies, it was not a significant factor for loss of reduction in this study. Factors except for the crossing point of K-wires may play a more important role in the outcomes of crossed-pin fixation.

Modified lateral approach combined with medial percutaneous approach versus triceps tongue-shaped flap approach and bilateral triceps brachii approach for pin fixation in treatment of irreducible displaced pediatric supracondylar humeral fractures

To evaluate the clinical outcomes of the modified lateral approach combined with the medial percutaneous approach (MLACMPA) versus the triceps tongue-shaped flap approach (TTSFA) and the bilateral triceps brachii approach (BTBA) in the treatment of irreducible displaced supracondylar humeral fractures (SHFs) in children. Between March 2000 and July 2022, a total of 135 children who underwent open reduction and Kirschner wire cross internal fixation for irreducible displaced SHFs caused by trauma were retrospectively analyzed. According to the surgical approach, the patients were assigned to the TTSFA group (n = 36), the BTBA group (n = 40) and the MLACMPA group (n = 59). The duration of surgery, intraoperative blood loss, incision length, and elbow range of motion were compared. The 3 groups were similar in terms of mean age, sex distribution, and time from injury to operation. The duration of surgery, intraoperative blood loss, incision length and postoperative elbow range of motion in the MLACMPA group were significantly superior to those in the TTSFA group and BTBA group (P < .05). Compared the use of the TTSFA or the BTBA, using the MLACMPA for pin fixation in the treatment of irreducible displaced pediatric SHFs could significantly shorten the duration of surgery, reduce the operation trauma, facilitate earlier functional exercise of joints after operation and yield better elbow function.

Douyin as a source of information and education on humeral supracondylar fracture of children during the COVID-19 pandemic in Chinese Mainland: An observational study

We aimed to investigate whether Douyin videos on pediatric humeral supracondylar fractures could be a useful source during the COVID-19 pandemic. A search was conducted using the term "humeral supracondylar fracture of children" on Douyin. The top 100 videos were selected based on view count. 74 was the final analysis, after excluding 26 videos for various reasons. First, the videos were classified into medical and the non-medical groups based on authorship. The medical team videos were about explanations or detailed surgical procedures directly related to child's fracture. There were also non-medical videos, mostly about personal experiences and other things. The videos were then also divided into 2 groups abased on the year of COVID-19 pandemic. The number of views, content type, video duration and number of likes about the video were analyzed. Among the 74 videos included in this study, had a total of 19,647,988 views (median 205,129, range 7874-1,495,004). Compared to the medical group, the non-medical group had more views (P = .004), likes (P = .000), view ratio (P = .019), and video power index (P = .024). During the COVID-19 pandemic, views (P = .033), view ratio (P = .006), and video power index (P = .043) also increased. Douyin has been a valuable source of health information for patients during COVID-19 pandemic regarding the occurrence of humeral supracondylar fracture in children. Medical professionals and institutions should upload credible, informative videos and clear, high-quality, scientifically reviewed surgical footage of children with humeral supracondylar fracture. And the videos uploaded by medical professionals and filtered by Douyin's staff appear to be necessary.

Factors Influencing Functional Outcomes in Supracondylar Humerus Fractures: A Retrospective Study of Paediatric Patients in a Level One Trauma Centre

Background The outcomes after fixation of the supracondylar humerus fracture (SCHF) are not documented in the current literature. In our study, we endeavour to determine the factors that influence the functional outcome and gauge their respective impact. Methodology We retrospectively reviewed the outcomes of patients who presented to our tertiary care centre (Royal London Hospital) with SCHFs between September 2017 and February 2018. We analysed patient records to assess several clinical parameters, including age, Gartland's classification, comorbidities, time to treatment, and fixation configuration. We conducted a multiple linear regression analysis to determine each of the clinical parameter's impact on the functional and cosmetic outcome, as reflected in Flynn's criteria. Results We included 112 patients in our study. Pediatric SCHFs had good functional outcomes based on Flynn's criteria. There was no significant statistical difference in functional outcomes with respect to sex (p= 0.713), age (p= 0.96), fracture type (p= 0.14), K-wire configuration (p=0.83), and time elapsed since surgery (p= 0.240). Conclusions Our results demonstrate that good functional outcomes can be expected with paediatric SCHFs based on Flynn's criteria, regardless of age at injury, sex, or pin configuration, provided satisfactory reduction is achieved and maintained. The only variable with statistical significance was Gartland's grade; Grades III and IV were correlated with poorer outcomes.

Analysis of the location and trajectory of the Kirschner wires in the fixation of extension-type supracondylar fracture of the humerus by 3D computational simulation

BACKGROUND

Closed reduction and percutaneous pinning is still a preference for the treatment of supracondylar humerus fractures in children. However, no reports have shown the pin trajectory and the characteristics of the entry point so far. So we established a computational simulation model of the elbow to observe the trajectory of pinning for supracondylar humerus fractures.

METHODS

We reconstructed an adult elbow computationally and simulated pin placement through lateral and medial pinning. Pin trajectories were traced after placement and after the addition of the skin profile; the relative entry points of the pins were determined. We used the center of the dorsal olecranon inflection as an anatomic reference for the entry points of lateral pinning. Four quadrants were established based on the center of the dorsal olecranon inflection: upper medial quadrant, upper lateral quadrant, lower medial quadrant, and lower lateral quadrant (LLQ).

RESULTS

The maximum angle of pinning through the lateral column was 64° ± 3°. The minimum angles of pinning through the lateral column and middle column were 37° ± 3° and 20° ± 2°, respectively. The range of safe angle pinning through the medial column was between 18° ± 2° and 57° ± 3° to avoid penetration of the olecranon fossa and the cortex of the medial column. The entry points of lateral pinning were within the lateral half of the LLQ, and the lateral one-third of the LLQ contained all entry points of the pins through the lateral column and minor points of the pins through the middle column. The exit points of the medial pinning were within the lateral fringe of the metaphyseal-diaphyseal junction region; entering from the inferior two-thirds of the medial epicondyle could lead to the exit points in the proximal half of the metaphyseal-diaphyseal junction region laterally.

DISCUSSION

For lateral pinning, the entry points would be within the lateral half of the LLQ. For the pins through the lateral column, the entry points should be within the lateral one-third of the LLQ. For medial pinning, entering from the inferior two-thirds of the medial epicondyle would lead to a more proximal exit.

Pediatric Sports Injuries

Pediatric sports injuries are becoming more prevalent as children participate in sports. This has resulted in more imaging of pediatric injuries. The growing skeleton has features that result in unique injury patterns and radiologic findings. The article discusses the special features of bones including the growth plate, apophyses, cortex, and periosteum. Pediatric-specific sports injuries and conditions in the most common joints are then reviewed including the elbow, hip, and knee. The imaging appearances of these entities will be described with a multimodality approach including radiographs, CT, ultrasound, and MRI. The most important radiologic findings to identify will be highlighted throughout the article.

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis

Objectives

This study aims to investigate the effects of the angles created by the Kirschner wires (K-wires), which are applied in the percutaneous fixation of supracondylar humerus fractures with cross K-wire, with the fracture line on fracture stabilization.

Patients and methods

The study was conducted on distal humerus fracture models. Medial and lateral K-wires were placed in the fracture models. The angle between the fracture line and the K-wire inserted from medial was represented by alpha (α), while the angle between the fracture line and the K-wires inserted from lateral was represented by beta (β). A combination of various angles (30°, 45°, and 60°) was used in each model, where no two models had the same combination of α and β, resulting in nine different wire configurations. The simulation program was used to simulate the effects of forces, which were applied on rotation, flexion and extension directions, on these models. We measured and compared the stress on the wires and the displacement of fractures under different force configurations.

Results

When the force was applied in the counterclockwise direction, the stresses were 58 megaPascal (MPa) on medial K-wire, 24 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. When the force was applied in the clockwise direction, the stresses were 57 MPa on medial K-wire, 23 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. In all models, the increased α and β angles were translated into the decreased stress on K-wires at the fracture level and decreased displacement under rotational deforming forces. Despite having generally lower fracture displacement, the increased α and β angles led to variable changes in the stress on K-wires against flexion and extension forces.

Conclusion

In supracondylar humerus fractures, increasing the insertion angle of both medial and lateral K-wires augments stabilization and reduces displacement, particularly against rotational deforming forces.

Is the modified Gartland classification system important in deciding the need for operative management of supracondylar humerus fractures?

PURPOSE

This study examined levels of agreement between paediatric orthopaedic surgeons in the need for operative management of extension-type supracondylar humerus fractures.

METHODS

This was the second phase of a two-part study. De-identified baseline anteroposterior and lateral elbow radiographs from 60 paediatric patients with extension-type supracondylar humerus fractures were compiled. After classifying each fracture according to Gartland classification guidelines, radiographs were randomized, and surgeons indicated whether they would use operative or non-operative management to treat each fracture. Kappa statistics using pairwise comparisons were calculated to determine agreement levels.

RESULTS

In total, 11 international surgeons participated, and 10/11 completed both survey rounds. The overall weighted interobserver agreement was moderate (0.530, 95%CI [0.215,0.854]) while overall weighted intraobserver agreement was substantial (0.740, 95%CI [0.513,0.963]). The largest variability in preferred treatment methods between surgeons was observed for type IIA fractures, with 6/11 preferring non-operative and 5/11 preferring operative management. The largest individual surgeon variability was observed for type IIA fractures, with 8/11 showing variability (defined by not having made the same decision for at least 90% of the cases) in choosing whether to operate.

CONCLUSIONS

Our findings suggest moderate interobserver, and substantial intraobserver agreement in treatment decision making. The largest disagreements between surgeons were observed for type IIA and IIB fractures and treatment decisions did not follow expected trends based on surgeons' preferred treatment methods for each fracture type. This suggests differences in treatment approaches between surgeons in the management of type IIA fractures and highlights the role of other variables that underlie differences between surgeons' treatment preferences.

LEVEL OF EVIDENCE

III.

Methodological Challenges in Investigating Supracondylar Fractures of the Humerus From a Child's Viewpoint: Evolution of Study Protocol

Background

Outdoor play and risk-taking behaviors, including play at heights, are important to children’s physical, social, and cognitive development. These aspects of play are important to consider when informing prevention policies for serious injuries that commonly occur on play structures. Supracondylar fractures of the humerus (SCH) are the most common type of elbow fractures that result from falls on an outstretched hand among healthy children. Despite being one of the leading causes of admission to the hospital and surgical intervention, the details surrounding the cause of these injuries are often not recorded. Previous research has correlated decreased overall playground safety with higher rates of SCH fractures. Play structure height and the type of undersurface have been identified as potential risk factors for severe injuries, including SCH fractures, in part due to low compliance with safety standards. This paper explores the challenges we encountered designing the study and the resulting insights and methodological modifications we made.

Objective

The aim of this paper is to discuss the challenges related specifically to clinical research in pediatrics and strategies developed to conduct a study that prioritizes the engagement and perspective of children and their families.

Methods

To explore the link between the severity of SCH fractures and children’s behavioral, environmental, and mechanistic factors, we conducted a mixed-methods study.

Results

During phase 1 (the original methodology) from April 2017 to July 2018, there were 58 eligible study participants and 17 were recruited. For phase 2 (the revised methodology) between October 2018 and October 2019, there were 116 eligible participants and 47 were recruited.

Conclusions

The changes in methodology made following the first phase of data collection were effective in our ability to recruit participants. By identifying and addressing challenges pertaining to recruitment and resource limitations, we were able to collect data in a concise manner while not compromising the quality of the data and make for an easily adoptable methodology for other sites interested in participating in the study. We hope that future studies that plan to employ a similar methodology can gain insight through the methodological challenges we have encountered and the way we adapted the methodology to build a more pragmatic approach.

International Registered Report Identifier (IRRID)

DERR1-10.2196/21816

Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues

BACKGROUND AND AIMS

Lateral-only Kirschner-wire pinning of supracondylar humerus fracture is superior in avoiding surgery-related ulnar nerve injury. Their disadvantageous effects on stability may be a consequence of inappropriate surgical techniques. We analyzed whether the surgeon's preference for lateral-only fixation is associated with his or her orthopedic competence. We also analyzed the surgical technique-related risk factors of redisplacement.

MATERIALS AND METHODS

All children, aged <16 years, with a distal humerus fracture in 2000-2009 were preliminary included (N = 861). Altogether, 24 of the 165 type-3 supracondylar fractures were operated by lateral-only pinning. Loss of reduction in the follow-up was the main outcome, while the close characteristics of the surgical technique and treating surgeon's orthopedic competence were the explanatory variables.

RESULTS

Orthopedic surgeons used lateral-only method in 23.5% of the type-3 fractures (N = 16/68), and other surgeons in 8.2% (N = 8/97)(difference = 15.3%, 95% confidence interval = 4.6%-27.6%, p = 0.005). One-third of the lateral-only treated fractures (29.2%, 95% confidence interval = 12.6%-51.1%) redisplaced. Lateral-entry pins that crossed at the level of the fracture were associated with failure (87.5%), while no patient with appropriate pin configuration failed (difference = 87.5%, 95% confidence interval = 52.1%-97.8%). A shorter distance (<5 mm) between the entry points of the pins was associated with redisplacement (80% vs. 15.8%, difference = 64.2%, 95% confidence interval = 16.1%-86.9%). Open reduction (p = 0.07), insufficient (<4 mm) bone contact (p = 0.28), monocortical pins (p = 0.569), low diverging angle (p = 0.13) or parallel pins (p = 1.0), residual coronal displacement (p = 1.0), >5° changed Bauman angle (p = 0.11), rotational displacement (p = 0.25), and the experience or specialty of the surgeon were not associated with redisplacement.

CONCLUSION

Lateral-only pins resulted in poor stability in one in three of the patients. Appropriate configuration of the pins was associated with good fracture healing, but crossing the pins at the fracture level and introducing them close to each other were associated with redisplacement. Surgeons with more orthopedic competence selected lateral-only fixation more usually.

The Emergency Evaluation and Management of Pediatric Extremity Fractures

Approximately one-third of children sustain a fracture before the age of 16 years; however, their unique anatomy and healing properties often result in a good outcome. This article focuses on the diagnosis and management of pediatric extremity injuries. The article describes the anatomic features and healing principles unique to children and discusses pediatric upper and lower extremity fractures and presents evidence-based and standard practice for their management. Finally, the article describes the conditions under which emergency physicians are likely to miss pediatric fractures by highlighting specific examples and discussing the general factors that lead to these errors.

Auxiliary Kirschner wire technique in the closed reduction of children with Gartland Type III Supracondylar humerus fractures

This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).In group A, the average operation time was 20.5 ± 8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ± 1.1, the average fracture healing time was 6.2 ± 1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ± 10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ± 1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.

Pinning of supracondylar fractures in children - Strategies to avoid complications

In the pediatric population supracondylar humerus fracture (SHF) is one of the most common injuries. Diagnosis is based on inspection and conventional radiography. SHFs should be classified according to the modified Gartland classification, which guides treatment. Non-displaced or minimally displaced fractures (Gartland type-I) should be treated non-operatively, completely displaced type III fractures require closed reduction and K-wire fixation. In type-II fractures, important landmarks, such as the anterior humeral line (Roger´s line), the shaft-physeal angle (Baumann´s angle) and the shaft condylar angle should be considered to guide treatment. Special attention has to be paid for potential rotational dislocation, which is indicated by a ventral spur. In such cases surgery is necessary. The degree of acceptable extension malpositioning depends on patient´s age. In 10-year-old children fractures with a shaft condylar angle of more than 15° are still suitable for non-operative therapy. Timing for surgery is controversially discussed. Postponing surgery to the next day seems reasonable if absence of pain, intact soft tissue and normal neurovascular status are present. Neurovascular complications are not uncommon, especially in Gartland type-III fractures and in cases with additional forearm injuries. A white hand without palpable pulse needs emergency surgery, the management of the pulseless pink hand is still controversially discussed. Different operative techniques exist for surgical treatment. The golden standard is closed reduction and percutaneous K-wire pinning. Crossed pinning seems to achieve best biomechanical stability. Since ulnar nerve injuries are reported to occur in 6% after medially inserting K-wires, lateral divergent insertion of two K-wires has been compared to crossed pinning fixation in several randomized controlled trials. Meta-analyses demonstrated a higher risk for ulnar nerve injury for the crossed pinning technique while risk for loss of fixation was higher in lateral only pinning. In both cases, K-wires should be removed 3-6 weeks after surgery with consolidation of the fracture. Clinical and radiological follow-up should be carried out at 3 weeks post fracture fixation to rule out loss of reduction. If this should occur, early revision surgery has been demonstrated beneficial.

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

Supracondylar humeral fractures (SCHF) are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I) is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III) of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4%) were boys and 17 (26.6%) were girls. The most common age range (59.4%) in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.

Based on the results of the analysed parameters, consisting primarily of functional results, the absence of subjective symptoms and myositis ossificans one year after surgery suggests that emergency surgical treatment of displaced supracondylar humeral fractures is optimal.

The long-term outcome of childhood supracondylar humeral fractures: A population-based follow up study with a minimum follow up of ten years and normal matched comparisons

AIMS

We present the clinical and radiographic outcome of 81 children with Gartland type I to III supracondylar humeral fractures at a minimum follow-up of ten years (mean 12.1 years; 10.3 to 16.1) following injury.

PATIENTS AND METHODS

The clinical and functional outcomes are compared with normal age- and gender-matched individuals. The population-based study setting was first identified from the institutional registries; the rate of participation was 76%. Controls were randomly selected from Finnish National Population Registry.

RESULTS

According to Flynn's criteria, most fractures (75.3%) resulted in a satisfactory ("good or excellent") outcome. Satisfactory recovery was achieved in 75.0% of type I fractures treated by closed splinting (p = 0.013). Type II fractures were associated with both satisfactory (57.7%) and unsatisfactory (42.3%) results, regardless of the type of treatment, although the numbers were small in the sub groups. Most type III fractures were treated operatively, and most (76%) had a satisfactory outcome according to Flynn's criteria (p = 0.015). Compared with none among the normal subjects, flexion of the elbow was reduced by > 10° at long-term follow-up in 20 cases (24.7%, p < 0.001) and 9 (11.1%) had a reduced flexion of > 15° (p = 0.004). In patients who had sustained a type III fracture, the carrying angle was decreased by 35.7% (from 9.8° to 6.3°; p = 0.048). All patients achieved an excellent Mayo Elbow Performance Score (mean 96.4 points).

CONCLUSION

The long-term outcome of extension-type supracondylar humeral fractures is generally good, but not exclusively benign, with the potential for long-term pain and ulnar nerve sensitivity, and a decrease in grip strength and range of movement in type II and type III fractures. Bony remodelling cannot be relied upon to correct any residual deformity. In particular, type II fractures have impaired long-term recovery and justify individual consideration in their treatment. Cite this article: Bone Joint J 2016;98-B:1410-17.

[Nerve injuries after elbow luxation fractures in childhood : Indication and timing for surgical revision]

BACKGROUND

Supracondylar humerus fractures are very common in pediatric populations. In cases of dislocated fractures, closed reduction and percutaneous K‑wire fixation is recommended. Initially, 10-16 % of the patients also present lesion of the ulnar nerve as well as median nerve palsy in 6.4% and radial nerve palsy in 2.6 % of cases, respectively.

METHOD

We present the case of a 10-year-old boy with a dislocation of the elbow and fracture of the medial epicondyle. After closed reduction and K‑wire fixation from medial, he presents a median nerve palsy. That a lesion of the ulnar nerve is also present is only noticed 3½ years posttraumatically. A surgical decompression and neurolysis of the ulnar and median nerve is performed and the postoperative grip and key strength presented.

DISCUSSION

With the help of the presented case we discuss the indication and the point of surgical revision. Clinical assessment and neurosonography are essential for an exact diagnosis.

Surgical Treatment of Displaced Supracondylar Pediatric Humerus Fractures: Comparison of Two Pinning Techniques

The aim of this study is to report the results of the treatment of displaced supracondylar humerus fractures comparing two different techniques, crossed and lateral pins. We retrospectively reviewed 35 children hospitalized between May 2005 and December 2012. Patients were treated with two different pin configurations, crossed (Group 1) and lateral (Group 2). After surgery, clinical and radiographic evaluation was performed. Postoperatively, the clinical assessment showed recovery of joint function of the elbow. Radiographically, Group 1 showed a difference in the Baumann angle between the value of the injured limb and the normal angle of 5.3° ± 2.12°; in Group 2 the difference was 4.9° ± 2.82°. Complications: group 1, two cases of short paresthesia, one case of slight varus, mild asymmetry, and deficit to extension of the humerus and group 2, two cases of local infection and one of a slight hyperextension were reported. Both groups achieved a satisfying outcome with similar results in joint function recovery and complications.