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Temporary Use of Skeletal Traction in Management of Pediatric Supracondylar Humeral Fractures
1Oddział Urazowo-Ortopedyczny, Świętokrzyskie Centrum Pediatrii, Wojewódzki Szpital Zespolony, Kielce, Polska / Department of Orthopaedics, Świętokrzyskie Pediatrics Center, Regional Hospital, Kielce, Poland.
Insights
This study evaluated a treatment algorithm for pediatric supracondylar humeral fractures, showing high success rates with closed reduction and percutaneous fixation, even after initial failure. Skeletal traction effectively manages complex cases, leading to good outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric traumatology
- Skeletal fracture management
Background:
- Supracondylar humeral fractures are common in children.
- Treatment algorithms aim to optimize outcomes for these fractures.
- This study assesses a specific algorithm involving closed reduction and percutaneous fixation (CRPF) with adjunctive skeletal traction.
Purpose of the Study:
- To evaluate the efficacy of a treatment algorithm for pediatric supracondylar humeral fractures.
- To assess outcomes following primary CRPF and after secondary interventions like skeletal traction.
- To determine complication rates associated with the treatment algorithm.
Main Methods:
- A cohort of 149 children with extension-type supracondylar humeral fractures was studied.
- Treatment involved emergency CRPF, with skeletal traction used for failed reductions.
- Outcomes were assessed using modified Flynn criteria, noting neurological and vascular complications.
Main Results:
- 90.8% of patients treated with CRPF (primary or after traction) achieved good outcomes.
- The open reduction group had 87.5% good outcomes.
- Neurological and vascular complications were observed in 8% and 5.4% of cases, respectively.
Conclusions:
- X-ray-guided closed reduction and percutaneous K-wire fixation is a primary treatment for displaced pediatric supracondylar humeral fractures.
- Skeletal traction can facilitate successful repeat closed reduction after initial CRPF failure.
- The evaluated algorithm demonstrates effectiveness in achieving favorable treatment outcomes.
Background:
The paper presents a treatment algorithm for supracondylar humeral fractures in children, involving temporary use of skeletal traction following failure of primary closed reduction and percutaneous fixation (CRPF) and introducing closed reduction after management by skeletal traction. The aim of this study was to assess the outcomes of supracondylar humerus fracture treatment performed according to the algorithm.
Material And Methods:
The treatment was performed in 149 children (70 girls, 79 boys) with extension-type supracondylar humeral fractures. The study group was assessed with regard to a modified Gartland classification, neurological complications (12 children, 8%) and vascular complications (8 children, 5.4%). A total of 124 (83.2%) patients underwent emergency CRPF and 24 children (16.1%) received skeletal traction after a failed CRPF. After 2-6 days, an elective repeat CRPF procedure was attempted, which was successful in 17 children. The attempt failed in the other 7 children, who received traction and underwent open reduction under a single anesthesia. One child (0.7%) with a white and pulseless hand was treated by emergency open reduction and percutaneous fixation.
Results:
The study used the Flynn criteria modified by the author. After 6 months, the results in the group treated with CRPF (both primary and following skeletal traction) were good in 90.8% of patients, satisfactory in 8.5%, and poor in 0.7%, whereas in the open reduction and percutaneous fixation group, the results were good in 87.5% of cases and satisfactory in 12.5%.
Conclusions:
1. X-ray-guided closed reduction and percutaneous K wire fixation is a method of choice in the treatment of displaced supracondylar humeral fractures in children. If closed reduction fails, the surgeon is faced with a choice between primary open reduction and the use of direct traction through the olecranon. 2. The use of skeletal traction following failure of primary emergency CRPF results in local improvement in the fracture region and allows for scheduling an elective repeat delayed closed reduction and percutaneous K wire fixation procedure. 3. The algorithm used in clinical practice, based on literature reports and the author's experience, helps achieve good treatment outcomes.
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