Open Supracondylar Humerus Fractures in Children

A preclinical model for osteoarticular fracture fragment preservation for delayed re-implantation

Background

Open articular fractures often include contaminated, devascularized osteoarticular fragments that are critical for joint reconstruction. Definitive treatment is often delayed such that decontamination and preservation of critical fragments for joint reconstruction is highly desirable. To validate decontamination and preservation protocols for safe and effective preservation of osteoarticular fragments for re-implantation, a preclinical animal model for inducing type 3 open articular fractures with contaminated, devascularized osteoarticular fragments was developed and validated.

Materials and methods

With IACUC approval, purpose-bred hounds (n = 5) were humanely euthanized. Immediately following euthanasia, a penetrating captive bolt pistol with 1.25 grain cartridge centered on the cranial aspect of each distal humerus was discharged to create open fractures in 3 dogs (6 elbows). In 2 dogs, matched osteoarticular tissues from non-injured elbows (controls) were retrieved for comparison. Distal humerus, proximal radius, and proximal ulna osteoarticular fragments (n = 27) were immediately placed in Missouri Osteochondral Preservation System (MOPS) solution and stored at room temperature. Radiographic, chondrocyte viability, and quantitative microbial culture assessments were performed immediately (time-0) and at 7 and 14 days of storage.

Results

This preclinical canine model reliably produced type 3 open distal humeral fractures characterized by devascularized and contaminated osteoarticular fracture fragments. All fragments produced extensive microbial growth through 14 days of storage. Without decontamination, viable chondrocyte density in the fragments decreased significantly within 7 days, likely attributable to the profound contamination.

Conclusion

These data highlight the importance of developing a reliable method for point-of-care decontamination and preservation of osteoarticular fracture fragments for safe and effective reimplantation of articular fracture fragments for joint reconstruction.

Management of Open Supracondylar Humeral Fracture in Children: A Case Report and Literature Review

Open supracondylar humeral fractures (SHFs) are rare, and there have been few papers specifically addressing their management. In this report, we describe the management and 27-month outcomes of an open SHF. A healthy eight-year-old boy presented with open SHF of the right elbow and underwent percutaneous lateral fixation using two Kirschner wires (K-wire) after irrigation and debridement (I&D) through an anterior approach. Excellent outcomes were obtained without any complications over a 27-month follow-up period. The management of open SHFs in children is yet to be standardized; nevertheless, we believe that I&D is a crucial step, that well-done lateral entry K-wires could provide the required stability, that the anterior approach is logical, safe, and effective, and that the high healing potential of children is our ally in such injuries.