Blount Method in the Management of Supracondylar Fractures of the Humerus in Children

Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The objective of our study was to evaluate the results of supracondylar fractures of the humerus treated by this method in our department. This was a descriptive, longitudinal study with the prospective collection over a period of 12 months from May 2018 to April 2019. It focused on children aged 0 to 15 years treated in the Orthopedic Traumatology Department of the CHU of Kati for a supracondylar fracture of the humerus in extension. A minimum follow-up period of 6 months was necessary for inclusion. 12 patients were collected. The sociodemographic, anatomopathologic, therapeutic and evolutionary aspects were studied. The results were evaluated according to Flynn’s criteria. The male sex was predominant with a ratio of 2. The average age was 5.5 years. The average admission time was 12.5 hours. Domestic accidents were the main etiology (66.66%) and Type II fracture was the most frequent with 58.33%. The duration of immobilization was 42 days for 11 patients. Complications were 1 case of secondary displacement and 1 case of 12&#730 flexion deficit. The average Baumann angle was 72&#730. The result was satisfactory for all our patients. Supracondylar fractures of the humerus are common in children, especially boys. The method of Blount when it is well carried out by respecting the indications gives good results.

Treatment of femur supracondylar fracture with retrograde interlocking intramedullary nails in elderly patients

Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.

Clinical significance of Baumann's angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children

To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.

Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study

BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.

Epidemiologic pattern of paediatric supracondylar fractures of humerus in a teaching hospital of rural India： A prospective study of 263 cases

Purpose： This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries. Methods： All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years. Results： We analysed a total of 263 patients and most of the fractures were seen in 5-8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 （23.95%） and type 2 （21.67%）. Conclusion： Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.

Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture:A retrospective cohort study

BACKGROUND The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning(CRPP). However, there is debate regarding the technique that is utilized, whether crossed or lateral pinning, and the number of pins used.AIM To compare the functional and radiological outcomes of lateral and cross pinning in the management of humeral supracondylar fracture.METHODS A retrospective analysis was performed on 101 patients who were surgically managed by either one of the CRPP techniques from 2015 to 2019. Several clinical parameters were taken into account, including pre-and post-intervention Baumann angle, as well as scores for pain, range of motion, function, and stability. Statistical analysis was performed to study the outcomes of the utilized techniques.RESULTS Amongst our study sample, which included 63 males and 38 females with a mean age of 5.87 years, about one-third of the patients underwent crossed pinning fixation configuration and the remaining two-thirds were managed by lateral pinning configuration. Similar results were obtained in the two groups with no statistical difference regarding Mayo elbow performance scores(MEPS) and Baumann angle. The mean MEPS in the lateral and crossed pinning groups were 93.68 + 8.59 and 93.62 + 9.05, respectively. The mean Baumann angle was 72.5° + 6.46 in the lateral group and 72.3° + 4.70 in the crossed-pinning group(P = 0.878).CONCLUSION Both lateral pinning and crossed pinning fixation configuration for displaced pediatric supracondylar humeral fractures provide similar functional and radiological outcomes.

Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.

Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus： A rare injury

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neumvascular injury due to fracture fragments following this type of fracture is described, latrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children

Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.

The Effect of Weather Conditions on Pediatric Supracondylar Humerus Fractures

Background: Environmental conditions are effective on childhood supracondylar humerus fractures. In this study, we evaluated the relationship between weather conditions and these fractures. Materials and Methods: We started this study following the approval of a non-interventional research ethics committee. Patients (<16 years) who applied to the hospital between January 2013 and July 2018 with supracondylar humerus fractures were included in the study. The hospital’s PROBEL system was used to diagnose (International Classification of the Diseases, ICD, S42.4) radiological images and patient information. Information on the weather conditions in the day and time period, in which supracondylar humerus fracture occurred, was obtained from TR (Turkey) Ministry of Agriculture and Forestry General Directorate of Meteorology. The relationship between supracondylar fracture and daily weather conditions (wind, air temperature, cloudiness, and season) was analyzed. Results: Most of the patients (n = 76, 40.6%, p < 0.05) were fractures occurring under cloudless weather conditions. Fractures were concentrated with a second frequency in cloudy weather over 60%, except for cloudless weather conditions (n = 51, 27.3%, p < 0.05). In the summer months when the air temperature was high, the number of fractures was higher (n = 62, 33.2%, p < 0.05) and less in the winter months (n = 24, 12.8%, p < 0.05). In hot weather conditions where the daily average temperature was above 20°C, supracondylar humerus fractures were observed more (n = 101, 54%) and less than 10°C (n = 43, 23%, p < 0.05). Increased incidence of fractures was observed in the presence of wind (n = 4, 2.1%, p < 0.05). Conclusion: Supracondylar humerus fractures are common in children. Environmental conditions (temperature, wind, and season) can be effective in the occurrence of these fractures.

CLOSED REDUCTION AND PERCUTANEOUS K-WIRES FIXATION OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K wires fixation Results. All patients’ K wires were removed at 4 weeks post operation Their elbow function regained at 8 weeks The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed very well without any permanent complications Two transient nerves palsy,ulnar and radial nerve each, recovered completely at 12 weeks and 16 weeks post operation respectively Conclusion. Closed reduction and percutaneous K wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children

Modified fixation for periprosthetic supracondylar femur fractures:Two case reports and review of the literature

BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.

The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports

Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.

Effectiveness of an early operating room start time in managing pediatric trauma

BACKGROUND The timing of operative treatment for pediatric supracondylar humerus fractures(SCHF)and femoral shaft fractures(FSF)remains controversial.Many fractures previously considered to be surgical emergencies,such as SCHF and open fractures,are now commonly being treated the following day.When presented with an urgent fracture overnight needing operative treatment,the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.AIM To describe the effect of a program allowing an early operating room(OR)start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.METHODS Starting in October 2017,patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00.We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.RESULTS Of the 44 SCHF meeting inclusion criteria,16 received treatment before imple mentation while 28 were treated after.After implementation,the mean wait time for surgery decreased by 4.8 h or 35.4%(13.4 h vs 8.7 h;P=0.001).There were no significant differences in the operative duration,time in the post anesthesia care unit,and wait time for discharge.Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons.Whereas 57%of the surgeons believed that the program was effective,only 9%of anesthesiologists and 16%of nurses agreed.The program was ultimately discontinued given the dissatisfaction.CONCLUSION Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders.Although the program produced promising results,it also created new conflicts within the OR staff that led to its discontinuation at our institution.Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.

Retrograde interlocking intramedullary nailing under arthroscopy for supracondylar femoral fracture

Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.