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Surgical Technique: Closed Reduction and Percutaneous Pinning of Posterolaterally Displaced Supracondylar Humerus
Vincent W Prusick1, Joseph T Gibian2, Kirsten E Ross1
1Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Insights
Pediatric Gartland type III posterolateral humerus fractures require optimal reduction techniques. This study details a lateral pin-only fixation method using intact periosteum for anatomical realignment.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Traumatology
Background:
- Gartland type III posterolateral (IIIB) supracondylar humerus fractures are prevalent in children.
- These fractures pose risks of neurovascular compromise and long-term deformity like cubitus varus.
- Optimal closed reduction and percutaneous pinning techniques remain debated.
Purpose of the Study:
- To discuss the management of Gartland III posterolateral supracondylar humerus fractures.
- To provide an in-depth technical description of operative fixation methods.
- To present a specific lateral pin-only fixation technique.
Main Methods:
- Description of a lateral pin-only fixation technique for Gartland III posterolateral supracondylar humerus fractures.
- Utilizing intact periosteum during reduction to aid anatomical realignment of distal fragments.
- Detailing a safe medial-based pin placement for persistent rotational instability.
Main Results:
- The described lateral pin-only technique facilitates anatomical reduction of medial and lateral columns.
- Periosteal integrity aids in achieving proper alignment.
- Medial pin placement effectively addresses residual rotational instability.
Conclusions:
- A lateral pin-only fixation technique is effective for Gartland III posterolateral supracondylar humerus fractures in pediatric patients.
- This method leverages periosteal integrity for anatomical reduction.
- It offers a viable solution for managing rotational instability.
Summary:
Gartland type III posterolateral (IIIB) supracondylar humerus fractures are common among the pediatric population and can lead to concomitant injury, including compromise of the brachial artery and median nerve and long-term deformity, such as cubitus varus. These fractures can be difficult to reduce, and there is little consensus regarding the optimal technique for closed reduction and percutaneous pinning. Here, we discuss the management of Gartland III posterolateral supracondylar humerus fractures, including an in-depth technical description of the methods of operative fixation. We describe a lateral pin-only fixation technique for Gartland III posterolateral supracondylar humerus fractures that uses the intact periosteum during reduction of the distal fragment to assist in realigning the medial and lateral columns anatomically. We also discuss a safe method for placing a medial-based pin if there is persistent rotational instability at the fracture site after placement of the laterally based pins.
