Trans-olecranon fossa four-cortex purchase lateral pinning in displaced supracondylar fracture of the humerus – a prospective analysis in 48 children ☆

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective

The current study aims at a functional analysis of trans-olecranon lateral pinning for displaced supracondylar fracture of the humerus (SCFH) in children.

Methods

A prospective study of 48 children (30 males, 18 females; mean age: 7.4 years) with displaced SCFH was treated at this institution with modified technique from March 2011 to September 2014. Cases were selected on the basis of inclusion criteria. The functional outcome was assessed clinically by modified Flynn's criteria along with achievement of full range of motion.

Results

All 48 children with a mean follow up of 20 months (range: 6–26 months) were assessed. All fractures united well. With modified Flynn's criteria, results were excellent in 40 children (83.3%), good in six children (12.5%), and fair in two children (4.2%). There were no poor results. Preoperative nerve palsies seen in four children recovered at ten weeks. Full range of motion was achieved on an average of 20 days after K-wire removal and no new post-operative nerve palsies were noted.

Conclusion

The modified trans-olecranon fossa four-cortex purchase (TOF-FCP) technique was promising in all cases of unstable SCFH without the complications of loss of reduction or iatrogenic ulnar nerve injury. This technique is simple, safe, and reproducible, with good clinical results in this type of fracture.

Resumo

Objetivo

O presente estudo teve como objetivo analisar funcionamente a fixação lateral através da fossa olecraniana em fraturas supracondilianas deslocadas do úmero (FSDU) em crianças.

Métodos

Estudo prospectivo de 48 crianças (30 do sexo masculino, 18 do sexo feminino, idade média: 7,4 anos) com FSDU, tratados nesta instituição entre março de 2011 e setembro de 2014 usando uma técnica modificada. Os casos foram selecionados com base em critérios de inclusão. O resultado funcional foi avaliado clinicamente pelos critérios de Flynn modificados, juntamente com a realização da amplitude de movimento completa.

Resultados

Todas as 48 crianças foram avaliadas, com seguimento médio de 20 meses (intervalo: 6 a 26 meses). Todas as fraturas apresentaram boa união. De acordo com os critérios de Flynn modificados, os resultados foram excelentes em 40 crianças (83,3%), bons em seis (12,5%) e razoáveis em duas (4,2%). Não foram observados resultados ruins. As paralisias nervosas pré-operatórias observadas em quatro crianças se resolveram após dez semanas. Os pacientes alcançaram amplitude completa de movimento em uma média de 20 dias após a remoção dos fios de Kirschner e não foram observadas novas paralisias nervosas pós-operatórias.

Conclusão

A técnica modificada de fixação em quatro corticais através da fossa trans-oleocraniana (FQC-FTO) foi promissora em todos os casos de FSDU instável, não apresentando complicações de perda de redução ou lesão do nervo ulnar iatrogênico. A técnica é simples, segura e reprodutível, com bons resultados clínicos nesse tipo de fratura.

Related collections

Most cited references 26

Record: found
Abstract: not found
Article: not found

Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up.

J C Flynn, J G Matthews, R L Benoit (1974)

0 comments Cited 102 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Lateral-entry pin fixation in the management of supracondylar fractures in children.

Ernest R. M. Kay, Arash Mostofi, Robert Skaggs … (2004)

There has been controversy regarding the optimal pin configuration in the management of supracondylar humeral fractures in children. A crossed-pin configuration may be mechanically more stable than lateral pins in torsional loading, but it is associated with a risk of iatrogenic injury to the ulnar nerve. Previous clinical studies have suggested that lateral pins provide sufficient fixation of unstable supracondylar fractures. However, these studies were retrospective and subject to patient-selection bias. A displaced supracondylar humeral fracture was fixed with only lateral-entry pins in 124 consecutively managed children. Medical records and radiographs were reviewed to identify any complications, including loss of fracture reduction, iatrogenic ulnar nerve injury, infection, loss of motion of the elbow, and the need for additional surgery. In addition, eight displaced supracondylar humeral fractures that had been reduced and fixed with lateral pins at other institutions and had lost reduction were analyzed to determine the causes of the failures. Sixty-nine children had a type-2 fracture, according to Wilkins's modification of Gartland's classification system; forty-three (62%) of those fractures were stabilized with two pins and twenty-six (38%), with three pins. Fifty-five children had a type-3 fracture; nineteen (35%) of those fractures were stabilized with two pins and thirty-six (65%), with three pins. A comparison of perioperative and final radiographs showed no loss of reduction of any fracture. There was also no clinically evident cubitus varus, hyperextension, or loss of motion. There were no iatrogenic nerve palsies, and no patient required additional surgery. One patient had a pin-track infection. Our analysis of the eight clinical and radiographic failures of lateral pin fixation that were not part of the consecutive series showed that the loss of fixation was due to fundamental technical errors. In this large, consecutive series without selection bias, the use of lateral-entry pins alone was effective for even the most unstable supracondylar humeral fractures. There were no iatrogenic ulnar nerve injuries, and no reduction was lost. The important technical points for fixation with lateral-entry pins are (1) maximize separation of the pins at the fracture site, (2) engage the medial and lateral columns proximal to the fracture, (3) engage sufficient bone in both the proximal segment and the distal fragment, and (4) maintain a low threshold for use of a third lateral-entry pin if there is concern about fracture stability or the location of the first two pins.

0 comments Cited 52 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement.

J. Hale, J. H. Duncan Bassett, C Kaminsky … (2001)

The commonly accepted treatment of displaced supracondylar fractures of the humerus in children is fracture reduction and percutaneous pin fixation; however, there is controversy about the optimal placement of the pins. A crossed-pin configuration is believed to be mechanically more stable than lateral pins alone; however, the ulnar nerve can be injured with the use of a medial pin. It has not been proved that the added stability of a medial pin is clinically necessary since, in young children, pin fixation is always augmented with immobilization in a splint or cast. We retrospectively reviewed the results of reduction and Kirschner wire fixation of 345 extension-type supracondylar fractures in children. Maintenance of fracture reduction and evidence of ulnar nerve injury were evaluated in relation to pin configuration and fracture pattern. Of 141 children who had a Gartland type-2 fracture (a partially intact posterior cortex), seventy-four were treated with lateral pins only and sixty-seven were treated with crossed pins. Of 204 children who had a Gartland type-3 (unstable) fracture, fifty-one were treated with lateral pins only and 153 were treated with crossed pins. There was no difference with regard to maintenance of fracture reduction, as seen on anteroposterior and lateral radiographs, between the crossed pins and the lateral pins. The configuration of the pins did not affect the maintenance of reduction of either the Gartland type-2 fractures or the Gartland type-3 fractures. Ulnar nerve injury was not seen in the 125 patients in whom only lateral pins were used. The use of a medial pin was associated with ulnar nerve injury in 4% (six) of 149 patients in whom the pin was applied without hyperflexion of the elbow and in 15% (eleven) of seventy-one in whom the medial pin was applied with the elbow hyperflexed. Two years after the pinning, one of the seventeen children with ulnar nerve injury had persistent motor weakness and a sensory deficit. Fixation with only lateral pins is safe and effective for both Gartland type-2 and Gartland type-3 (unstable) supracondylar fractures of the humerus in children. The use of only lateral pins prevents iatrogenic injury to the ulnar nerve. On the basis of our findings, we do not recommend the routine use of crossed pins in the treatment of supracondylar fractures of the humerus in children. If a medial pin is used, the elbow should not be hyperflexed during its insertion.

0 comments Cited 44 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Saravanan Kasirajan

Journal

Journal ID (nlm-ta): Rev Bras Ortop

Journal ID (iso-abbrev): Rev Bras Ortop

Title: Revista Brasileira de Ortopedia

Publisher: Elsevier

ISSN (Electronic): 2255-4971

Publication date PMC-release: 31 March 2017

Publication date Collection: May-Jun 2018

Publication date (Electronic): 31 March 2017

Volume: 53

Issue: 3

Pages: 342-349

Affiliations

[a ]Department of Orthopaedics, Vinayaka Missions Medical College and Hospital, Karaikal, India

[b ]BRJ Ortho Centre and Mak Hospital, Coimbatore, India

Author notes

[* ] Corresponding author. ksorthopaediccentre@ 123456gmail.com

Article

Publisher ID: S2255-4971(17)30040-X

DOI: 10.1016/j.rboe.2017.03.014

PMC ID: 5993884

PubMed ID: 29892587

SO-VID: dcfe9b41-12c5-4678-a61a-4fda24511959

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 5 January 2017

Date accepted : 23 February 2017

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.