Incidence of malunion in displaced supracondylar fracture of humerus in children after open reduction with K. wire fixation versus closed reduction with K. wire fixation
DOI:
https://doi.org/10.15218/zjms.2024.41Keywords:
Supracondylar humerus fracture, Close reduction, Open reduction, MalunionAbstract
Background and objective: commonest fracture of pediatric elbow is the fractures of supracondylar of humerus. Gartland type II and type III Management is preferably operation, either with closed reduction and K. wire pinning or with open reduction and K. wire fixation. Some of the patients will get post-operative complications including Malunion. The aim of this study is to sort out the incidence of malunion in management of fractures of supracondylar in children by closed reduction and K. wire pinning versus open reduction-lateral approach and K. wire pinning.
Methods: Forty nine children were included, who had Gartland type II and Type III Supracondylar fractures and underwent operative management, been enrolled using convenient sampling method. Patients are followed up after 12 weeks. During the review, assessment of the patient done for possible complications postoperatively and measured any possible change of degrees of carrying angle and movement loss at the elbow considering malunion complication.
Results: 12% of the patients who are treated with close reduction and K. wire pinning developed malunion, while none of the patients who are treated with open reduction-lateral approach and K. wire pinning developed malunion.
Conclusion: Incidence of malunion after treatment of supracondylar fracture of humerus in children with close reduction and K. wire pinning is more than the incidence by open reduction-lateral approach and K. wire pinning.
Metrics
References
Kumar V, Singh A. Fracture Supracondylar Humerus: A Review. J Clin Diagn Res 2016; 10(12):RE01-RE06. doi: 10.7860/JCDR/2016/21647.8942 Epub 2016. PMID: 28208961; PMCID: PMC5296534.
Isa AD, Furey A, Stone C. Functional outcome of supracondylar elbow fractures in children: a 3- to 5-year follow-up. Can J Surg 2014; 57(4):241–6. doi: 10.1503/cjs.019513 PMID: 25078928; PMCID: PMC4119115.
Holt JB, Glass NA, Shah AS. Understanding the Epidemiology of Pediatric Supracondylar Humeral Fractures in the United States: Identifying Opportunities for Intervention. J Pediatr Orthop 2018; 38(5):245–51 doi: 10.1097/BPO.0000000000001154 PMID: 29462120.
Shah RK., Rijal R, Shah Kalawar RP, Shrestha SR, Shah NK, "Open Reduction and Internal Fixation of Displaced Supracondylar Fracture of Late Presentation in Children: A Preliminary Report", Advances in Orthopedic Surgery 2016; 2016(1). doi: 10.1155/2016/9256540
Nayak AR, Natesh K, Bami M, Vinayak S. Is closed manipulative reduction and percutaneous Kirschner wiring of supracondylar humeral fracture in children as day-care surgery a safe procedure? Malays Orthop J 2013; 7(2):1–5. doi: 10.5704/MOJ.1307.006 PMID: 25722817; PMCID: PMC4341029.
de Gheldere A, Legname M, Leyder M, Mezzadri G, Docquier PL, Lascombes P. Reliability of the Lagrange and Rigault classification system of supracondylar humerus extension fractures in children. Orthop Traumatol Surg Res 2010; 96(6):652–5. doi: 10.1016/j.otsr.2010.03.021 PMID: 20696629.
Micheloni GM, Novi M, Leigheb M, Giorgini A, Porcellini G, Tarallo L. Supracondylar fractures in children: management and treatment. Acta Biomed 2021; 92(S3):e2021015. doi: 10.23750/abm.v92iS3.11725 PMID: 34313666; PMCID: PMC8420822.
Samelis PV, Papagrigorakis E, Ellinas S. Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method. Cureus 2019; 11(10):e6024. doi: 10.7759/cureus.6024. PMID: 31824792; PMCID: PMC6886656.
Skaggs DL, Glassman D, Weiss JM, Kay RM. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Child Orthop 2011; 5(4):305–12. doi: 10.1007/s11832-011-0349-z PMID: 22852037; PMCID: PMC3234893.
Duffy S, Flannery O, Gelfer Y, Monsell F. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol 2021; 31(5):871–81. doi: 10.1007/s00590-021-02932-2 PMID: 33744996; PMCID: PMC8233294.
Shah M, Agashe MV. Supracondylar Humerus Fractures: Classification Based Treatment Algorithms. Indian J Orthop 2020; 55(1):68–80. doi: 10.1007/s43465-020-00285-2 PMID: 33569100; PMCID: PMC7851217.
Barr LV. Paediatric supracondylar humeral fractures: epidemiology, mechanisms, and incidence during school holidays. J Child Orthop 2014; 8(2):167–70. doi: 10.1007/s11832-014-0577-0. PMID: 24643672; PMCID: PMC3965762.
Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res 2015; 473(2):738–41. doi: 10.1007/s11999-014-4033-8 PMID: 25361847; PMCID: PMC4294919.
Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM. Does the Modified Gartland Classification Clarify Decision Making? J Pediatr Orthop 2018; 38(1):22–6. doi: 10.1097/BPO.0000000000000741. PMID: 26974527.
Agashe M. Classifications of supracondylar humerus fractures: Are they relevant? Are we missing something? Int J Pediatr Orthop 2015; 1(1):6–10.
Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev 2018; 3(10):526–40. doi: 10.1302/2058-5241.3.170049 PMID: 30662761; PMCID: PMC6335593.
Garg S, Weller A, Larson AN, Fletcher ND, Kwon M, Schiller J, Browne R, Copley L, Ho C. Clinical characteristics of severe supracondylar humerus fractures in children. J Pediatr Orthop 2014; 34(1):34–9. doi: 10.1097/BPO.0b013e31829c0046. PMID: 23812149.
Pan T, Widner MR, Chau MM, Hennrikus WL. Open Supracondylar Humerus Fractures in Children. Cureus 2021; 13(3):e13903. doi: 10.7759/cureus.13903. PMID: 33880259; PMCID: PMC8046429.
Bălănescu R, Ulici A, Rosca D, Topor L, Barbu M. Neurovascular abnormalities in Gartland III supracondylar fractures in children. Chirurgia (Bucur) 2013; 108(2):241–4. PMID: 23618575.
Shenoy PM, Islam A, Puri R. Current Management of Paediatric Supracondylar Fractures of the Humerus. Cureus 2020; 12(5):e8137. doi: 10.7759/cureus.8137. PMID: 32550057; PMCID: PMC7294900.
Schultz JD, Rees AB, Wollenman LC, Lempert N, Moore-Lotridge SN, Schoenecker JG. Bruise Location in Supracondylar Humerus Fractures Predicts Specific Neurovascular Injuries. J Pediatr Orthop 2022; 42(3):250–6. doi: 10.1097/BPO.0000000000002027. PMID:34923508; PMCID: PMC8815824.
Ibrahim S. Tachdjian's Pediatric Orthopaedics: from the Texas Scottish Rite Hospital for Children. Malays Orthop J 2015; 9(1). doi: 10.5704/MOJ.1503.012. PMCID: PMC5349352.
DeFroda SF, Hansen H, Gil JA, Hawari AH, Cruz AI Jr. Radiographic Evaluation of Common Pediatric Elbow Injuries. Orthop Rev (Pavia) 2017; 9(1):7030. doi: 10.4081/or.2017.7030 PMID: 28286625; PMCID: PMC5337779.
Chen G, Cui L, Shi J, Zhang P, Li J, Wang Z, et al. Humerus trochlear angle (HTa)-a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures. BMC Musculoskelet Disord 2021; 22(1):950. doi: 10.1186/s12891-021-04717-4. PMID: 34781909; PMCID: PMC8594185.
Jain AK. Apley and Solomon's concise system of orthopedics and trauma. Indian J Orthop 2015; 49(2):264. PMCID: PMC4463756.
Iorio C, Crostelli M, Mazza O, Rota P, Polito V, Perugia D. Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures: What can help us choosing? J Orthop 2018; 16(1):31–5. doi: 10.1016/j.jor.2018.12.001. PMID: 30662234; PMCID: PMC6324759.
Abousaleh MA, Zeidan AA, Mukhtar I, Keshta AS, Aladraj TH, Shaaban OA, Keshta MS, Alqasim R. Comparative Effectiveness of Closed Reduction With Percutaneous Pinning and Open Reduction With Internal Fixation in the Operative Management of Pediatric Type III Supracondylar Fractures. Cureus 2022; 14(2):e22707. doi: 10.7759/cureus.22707. PMID: 35386149; PMCID: PMC8967402.
Mitchell SL, Sullivan BT, Ho CA, Abzug JM, Raad M, Sponseller PD. Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. J Bone Joint Surg Am 2019; 101(15):1351–6. doi: 10.2106/JBJS.18.01178. PMID: 31393425; PMCID: PMC7406141.
Carrazzone OL, Belloti JC, Matsunaga FT, Mansur NSB, Matsumoto MH, Faloppa F, Tamaoki MJS. Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review. JMIR Res Protoc 2017; 6(11):e232. doi: 10.2196/resprot.8343. PMID: 29162558; PMCID: PMC5717449.
Canales-Zamora OA, Mora-Ríos FG, Mejía-Rohenes LC, Anaya-Morales A, González-Gijón OR, López-Hernández JR. Complicaciones de fracturas supracondíleas humerales en niños [Complications of supracondylar humeral fractures in children]. Acta Ortop Mex 2020; 34(1). PMID: 33244908.
Verka PS, Kejariwal U, Singh B. Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy. J Clin Diagn Res 2017; 11(3):RC08-RC12. doi: 10.7860/JCDR/2017/24345.9551 PMID: 28511466; PMCID: PMC5427392.
You C, Zhou Y, Han J. A double-closed wedge broken-line osteotomy for cubitus varus deformity. Medicine (Baltimore) 2021; 100(23):e26124. doi: 10.1097/MD.0000000000026124. PMID: 34114995; PMCID: PMC8202564.
You C, Zhou Y, Han J. Loss of correction in cubitus varus deformity after osteotomy. Medicine (Baltimore) 2021; 100(49):e27848. doi: 10.1097/MD.0000000000027848 PMID: 34889234; PMCID: PMC8663885.
Irianto KA, Pradana IPGP, De Vega B. Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis. F1000 Res 2021; 10:573. doi: 10.12688/f1000research.53599.3 PMID: 35087661; PMCID: PMC8764559.
LiBrizzi CL, Klyce W, Ibaseta A, Shannon C, Lee RJ. Sex-based differences in pediatric supracondylar humerus fractures. Medicine (Baltimore) 2020; 99(20):e20267. doi: 10.1097/MD.0000000000020267
Barr LV. “Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays”. J Child Orthop 2014; 8(2):167–70. doi: 10.1007/s11832-014-0577-0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Mohammed Talaat Othman, Abdulkadr Muhammed Sleman Alany (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).
