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Supracondylar humerus fractures in children treated with closed reduction and percutaneous pinning
Michelangelo Scaglione1, Daniele Giovannelli, Luca Fabbri
1Department of Orthopedics, University of Pisa, Via Paradisa 2, Ed 3, 56100, Pisa, Italy. xario@hotmail.it
Insights
Pediatric supracondylar humerus fractures are best treated within 12 hours using closed reduction and lateral-entry K-wire fixation for Gartland types II and III. Type I fractures are managed conservatively with casting.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Supracondylar humerus fractures are common in children, often associated with serious complications.
- Management strategies for these fractures remain a subject of ongoing debate and controversy.
- This study presents clinical experience with a specific treatment protocol for pediatric supracondylar humerus fractures.
Purpose of the Study:
- To evaluate the efficacy and outcomes of treating pediatric supracondylar humerus fractures.
- To assess the long-term results of closed reduction and percutaneous pinning fixation.
- To provide evidence-based recommendations for the management of different fracture types.
Main Methods:
- A retrospective review of 150 pediatric supracondylar humerus fractures treated between 1989 and 2006.
- 125 cases with a follow-up of at least 5 years were analyzed (mean follow-up: 8.2 years).
- Fractures were classified using the Gartland/Wilkins system, and outcomes assessed with the Flynn classification.
Main Results:
- 100% of patients achieved normal elbow joint mobility without impairment.
- Minor angular deviations (valgus/varus) were observed in a small percentage of cases.
- Excellent or good results (Flynn classification) were achieved in 91% of treated patients.
Conclusions:
- Urgent (within 12 hours) closed reduction and lateral-entry K-wire fixation are recommended for Gartland types II and III supracondylar humerus fractures.
- Conservative cast treatment is appropriate only for Gartland type I fractures.
- Open reduction is reserved for open, irreducible, or vascularly compromised fractures.
Abstract:
Supracondylar fractures of the humerus in children are important for frequency and type of associated serious complications. The management of this kind of fractures is still controversial (Skaggs et al. in J Bone Joint Surg Am 86:702-707, 2004; Kalllio et al. in J Pediatr Orthop 12:11-15, 1992). We are going to present our experience in the treatment of supracondylar humeral fracture in children. In the Orthopedic Department of Pisa, we treated 150 cases from 1989 to 2006. We are used to perform, emergency or within 12 h, reduction and two lateral-entry percutaneous pins fixation. The mean age was 7.5 years. We checked 125 cases, because we excluded all the cases with follow up less then 5 years. The mean follow up was 8.2 years. We used Gartland classification modified by Wilkins. We evaluated 125 cases by using the Flynn classification: 100 % of patients did not have impairment of the elbow joint mobility. We had seven valgus deviation, one of which was more then 10°. We also had 17 varus deviations, 11 of which were not over 8° and only 2 of them were 15°. The average value of the joint Baumann angle was calculated as great as 16°. The obtained results were classified as very good 80 %, good 11 %, sufficiently good 6 %, and bad 3 %. In our experience, all the fractures type II and III by Gartland have to be treated within 12 h, with closed reduction and stabilization with lateral-entry K-wire technique. The conservative treatment by cast is indicated only in type I fracture. The trans olecranic treatment is not realizable, for the stiffness which can occur, for the risk of iatrogenic ulnar nerve lesion, and for long-time hospitalization. The open reduction remains the first choice treatment for exposed or nonreducible fractures, and in cases of vascular injury.
