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A Novel Technique of Arc Fixator for Supracondylar Humerus Fractures in Older Children: A Case Series
Amit Kumar1, Kumar Keshav1, Anurag Baghel1
1Department of Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
This study introduces a novel Arc fixator for displaced supracondylar humerus fractures, offering stable fixation and early elbow function. The innovative method allows for better post-operative monitoring and improved patient outcomes compared to traditional casting.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Displaced supracondylar humerus fractures are commonly treated with percutaneous pinning and casting.
- Traditional casting methods can impede post-operative neurovascular assessment and may lead to elbow stiffness, particularly in older children.
- Current fixation methods present challenges in monitoring for complications like swelling and neurovascular compromise.
Purpose of the Study:
- To evaluate the clinical, radiological, and functional outcomes of a novel Arc fixator for treating displaced supracondylar humerus fractures.
- To assess the safety and efficacy of this innovative fixation method in pediatric patients.
- To compare the advantages of the Arc fixator over traditional casting techniques.
Main Methods:
- A retrospective study involving ten pediatric patients with displaced supracondylar humerus fractures.
- Treatment was performed using the novel Arc fixator.
- Clinical, radiological, and functional results were assessed post-operatively.
Main Results:
- All ten patients achieved fracture union within six weeks.
- Patients experienced a near-normal range of motion without deformity at final follow-up.
- Three patients with pre-existing nerve palsy showed spontaneous recovery within three months; one patient had transient ulnar nerve palsy.
- Flynn criteria scores at three months were satisfactory.
Conclusions:
- The Arc fixator provides a stable and rigid construct for displaced supracondylar humerus fractures.
- This novel fixation method facilitates regular post-operative examination of the forearm and neurovascular structures.
- The Arc fixator allows for early elbow function and is patient-friendly, potentially reducing complications like stiffness.
Introduction:
Traditionally displaced supracondylar fractures of the humerus are treated by percutaneous pinning and above-elbow slab/cast support. Crossed pinning is commonly used as it provides better biomechanical stability than lateral pinning. The fracture is often associated with a high risk of complications such as neurovascular injury, pulselessness, and the development of swelling or compartment syndrome in acute scenarios. These clinical conditions require regular examination of neurovascular structures and forearm swelling, which is difficult with a slab or cast. Post-surgery Slab or cast has been found to be associated with elbow stiffness, which significantly increases in older children. Here we are presenting an innovative fixation method for such fracture.
Materials And Methods:
This retrospective study examined the clinical, radiological, and functional results of ten patients who had displaced supracondylar humerus fractures treated with our novel Arc fixator.
Results:
6 out of 10 patients (mean age: 8.2 years; 6-12 years) had a fracture of the non-dominant limb. Flexion injury was seen in one patient with transient ulnar nerve palsy. 3 patients who had injury-related nerve palsy (median 2/ulnar 1), recovered spontaneously at 3 months. Fracture union was observed in all at 6 weeks. All patients achieved a near-normal range of motion (ROM) without deformity at the final follow-up. They had satisfactory scores at 3 months according to Flynn criteria.
Conclusion:
The construct was found stable and rigid enough to provide fracture stability and allow intermittent ROM exercises. This new method of fixation has the added advantage of regular examination of forearm and neurovascular structures in the postoperative period and allowing early elbow function of the patient, along with being patient-friendly.
