Percutaneous Pinning of Supracondylar Fractures of the Humerus

Six cases of supracondylar fracture of the humerus in children were treated by closed reduction and percutaneous pinning with two Kirschner wires inserted laterally through the capitellum of the humerus. This treatment has the same advantages as the commonly used percutaneous pinning with crossed Kirschner wires inserted through the epicondyles of the humerus, and it further eliminates the risk of damaging the ulnar nerve by the insertion of the medial Kirschner wire.     

Supracondylar Fractures of the Humerus in Children

The treatment of type II and type III supracondylar fractures of the humerus in children with closed reduction and percutaneous pinning has dramatically lowered the rate of complications from this injury. The incidence rates of malunion (cubitus varus) and compartment syndrome have both decreased. Nerve injury accompanying this type of fracture (prevalence, 5% to 19%) is usually a neurapraxia, which should be managed conservatively. Vascular insufficiency at presentation (prevalence, 5% to 17%) should be managed initially by rapid closed reduction and pinning without arteriography. Persistent vascular insufficiency necessitates exploration and vascular reconstruction.     

Supracondylar Fractures of the Humerus in Children

Closed reduction and percutaneous pinning techniques for displaced supracondylar fractures of the humerus in children (Gartland type III) have overcome disastrous ischemic complications and long inpatient treatment. Closed reduction of those highly unstable fractures and the demanding pin placement itself are potential sources of failure for the inexperienced reflected by the rate of cubitus varus which is still about 5-15% in recent series. Rotational primary and residual displacement has to be appreciated to prevent permanent cosmetic deformity. Malrotation is the majour source of instability since bicolumnar support is lost which allows the distal fragment to tilt. Biomechanically tested better stability of crossed medial and lateral pins in comparision to two parallel lateral pins does not seem to be of practical importance.The risk of ulnar nerve injury by medial-pin fixation is not outweighed by significantly better clinical result. The rate of iatrogenic nerve injuries is 3-16% with the ulnar nerve being the most susceptible due to inadvertent pinning. Despite a high recovery rate, they are a nuisance for the patients. Fracture-related peripheral neuropathies have an incidence of 10-17%. With rare exceptions, concomitant nerve lesion recover spontaneously within a time range of 1-4 months. There is still controversy regarding the management of a post reduction pink, warm but pulseless hand with adequate capillary refill. Simple observation and conservative management lead to a favorable clinical outcome in most cases but cold intolerance or exercise-induced ischemic symptoms are a potential sequel.     

Displaced Supracondylar Fractures of the Humerus in Children

In a 3-year period, 101 children were admitted to hospital with supracondylar fractures of the humerus. Eighty-six were examined an average of 3.7 years after the injury.

Forty-seven cases were treated with closed reduction and plaster bandage. After an unsuccessful attempt at closed reduction, 39 cases were treated with percutaneous K-wire pinning and plaster.

The cases treated with percutaneous pinning thus include the most severe fractures. Nevertheless, the results at follow-up in these cases easily equalled those obtained by closed reduction of the less displaced fractures. They were also comparable with reported results of extension treatment and, in contrast, required only a few days of hospitalisation.     

闭合复位,经皮克氏针固定治疗儿童完全移位的肱骨髁上骨折

目的 评价闭合复位、经皮克氏针固定治疗儿童完全移位的肱骨髁上骨折的临床效果。方法从１９９７年２月～１９９８年７月在“Ｃ”型臂Ｘ线机透视下,采用闭合复位、经皮克氏针固定治疗儿童完全移位的肱骨髁上骨折共４３例。患儿的平均年龄为６岁７个月（２－１２．８岁）。伸直尺偏型２７例,伸直桡偏型１４例,屈曲型２例。在臂丛麻醉和“Ｃ”型臂Ｘ线机透视下,先行闭合整复骨折,然后经皮穿入两枚交叉克氏针固定。结果 本组４２     

Supracondylar Humerus Fractures: Classification Based Treatment Algorithms

Supracondylar humerus fractures are the most common fractures around the elbow in children between 4 and 10 years of age. The treatment of supracondylar humerus fractures can vary from conservative treatment to operative treatment depending on the fracture type. All around the world, the most commonly used classification system is the Wilkins-modified Gartland classification of supracondylar humerus fractures. Currently, the decision to operate or conserve the fracture is taken on basis of this classification system. Non-operative treatment for type I fractures and operative treatment for type III fractures have been well-established in literature. The management of type II supracondylar humerus fracture creates confusion in the minds of numerous orthopaedic surgeons around the world. We have tried addressing this using a classification-based treatment algorithm. Other classification systems like the AO classification, Lagrange and Rigault classification and Bahk classification with special reference to special fracture patterns that require attention and pre-op planning have also been mentioned. It is important to understand that operative management of each supracondylar humerus fracture is unique as regards fixation method and it is important to consider the fracture pattern before internal fixation.     

Bilaterotricipital Approach to the Elbow: Its Application in the Osteosynthesis of Supracondylar Fractures of the Humerus in Children

In nine children and adolescents, the motion of the distal fibula in relation to the tibia was measured by roentgen stereophotogrammetry. Between the extremes of ankle flexion, the fibular epiphysis moved on average 1.4 mm.