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Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children

  • Alaa A. Hussein al-Algawy
  • Adil Hasan AliakbarEmail author
  • Ibrahim H. N. Witwit
Original Article • ELBOW - FRACTURES

Abstract

Supracondylar fracture of the humerus is a common displaced type childhood fracture that is treated by two methods. To compare open and closed methods of reduction with 2 cross k-wire fixation, a retrospective comparative study of 66 paediatric patients with type III supracondylar fracture of the humerus, who were treated in two different hospitals utilizing two different protocols, was conducted. Group 1 was treated with open reduction and 2 cross k-wire fixation, and group 2 received the closed reduction and k-wire fixation protocol. Functional and cosmetic assessments were conducted utilizing the Flynn et al. outcome criteria. The test population consisted of 25 female (37.9%) and 41 male (62.1%) patients. There were 43 fractures (65.2%) in the right elbow and 23 fractures (34.8%) in the left. Group 2 (81.81%) stayed less than 4 days in the hospital, while 69.7% of group 1 stayed more than 5 days. Statistically, there were no significant differences (P > 0.05) between patients of both groups regarding the Flynn et al. criteria. Closed reduction technique was preferred because it required less hospitalization time and resulted in almost no visible surgical scars.

Keywords

Closed reduction Displaced fracture Supracondylar fracture Trauma 

Notes

Compliance with ethical standards

Conflict of interest

All named authors hereby declare that they have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Battaglia TC, Armstrong DG, Schwend RM (2002) Factors Affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop 22(22):431–439.  https://doi.org/10.1097/01241398-200207000-00004 Google Scholar
  2. 2.
    Matuszewski Ł (2014) Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children. Eur J Orthop Surg Traumatol 24:1401–1406.  https://doi.org/10.1007/s00590-013-1337-4 CrossRefGoogle Scholar
  3. 3.
    Bulut G, Sarıoğlu E, Mık G, Ofluoğlu Ö, Bekler Hİ (2012) Posterior bilaterotricipital approach for surgical treatment of children’s Gartland Type III supracondylar humeral fractures. Eur J Orthop Surg Traumatol 22:457–465.  https://doi.org/10.1007/s00590-011-0862-2 CrossRefGoogle Scholar
  4. 4.
    Houshian S, Mehdi B, Larsen MS (2001) The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 6:312–315.  https://doi.org/10.1007/s0077610060312 CrossRefGoogle Scholar
  5. 5.
    Flynn JC, Matthews JG, Benoit RL (1974) Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg 56:263–272.  https://doi.org/10.2106/00004623-197456020-00004 CrossRefGoogle Scholar
  6. 6.
    Furrer M, Mark G, Rüedi T (1991) Management of displaced supracondylar fractures of the humerus in children. Injury 22:259–262.  https://doi.org/10.1016/0020-1383(91)90001-U CrossRefGoogle Scholar
  7. 7.
    Mohammed S, Rymaszewski LA (1995) Supracondylar fractures of the distal humerus in children. Injury 26:487–489.  https://doi.org/10.1016/0020-1383(95)93594-8 CrossRefGoogle Scholar
  8. 8.
    Paradis G, Lavallee P, Gagnon N, Lemire L (1993) Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop Relat Res 231:231–237Google Scholar
  9. 9.
    Hadlow AT, Devane P, Nicol RO (1996) A selective treatment approach to supracondylar fracture of the humerus in children. J Pediatr Orthop 16:104–106.  https://doi.org/10.1097/01241398-199601000-00021 CrossRefGoogle Scholar
  10. 10.
    Ababneh M, Shannak A, Agabi S, Hadidi S (1998) The treatment of displaced supracondylar fractures of the humerus in children. A comparison of three methods. Int Orthop 22:263–265.  https://doi.org/10.1007/s002640050255 CrossRefGoogle Scholar
  11. 11.
    Haddad RJ Jr, Saer JK, Riordan DC (1970) Percutaneous pinning of displaced supracondylar fractures of the elbow in children. Clin Orthop Relat Res 71:112–117CrossRefGoogle Scholar
  12. 12.
    Nacht JL, Ecker ML, Chung SMK, Lotke PA, Das M (1983) Supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning. Clin Orthop Relat Res 177:203–209.  https://doi.org/10.1097/00003086-198307000-00031 Google Scholar
  13. 13.
    Pirone AM, Graham HK, Krajbich JI (1988) Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 70:641–650.  https://doi.org/10.2106/00004623-198870050-00002.Pubmed:3392056 CrossRefGoogle Scholar
  14. 14.
    Chen RS, Liu CB, Lin XS, Feng XM, Zhu JM, Ye FQ (2001) Supracondylar extension fracture of the humerus in children. Manipulative reduction, immobilisation and fixation using a U-shaped plaster slab with the elbow in full extension. J Bone Joint Surg Br 83:883–887CrossRefGoogle Scholar
  15. 15.
    Kotwal PP, Mani GV, Dave PK (1989) Open reduction and internal fixation of displaced supracondylar fractures of the humerus. Int Surg 74:119–122Google Scholar
  16. 16.
    Özkoc G, Gonc U, Kayaalp A, Teker K, Peker TT (2004) Displaced supracondylar humeral fractures in children: open reduction vs. closed reduction and pinning. Arch Orthop Trauma Surg 124:547–551.  https://doi.org/10.1007/s00402-004-0730-1 CrossRefGoogle Scholar
  17. 17.
    Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109:145–154Google Scholar
  18. 18.
    Rockwood CA Jr, Wilkins KE, Beaty JH (1996) Fractures in children, vol 3. Lippincott-Raven, PhiladelphiaGoogle Scholar
  19. 19.
    Mehlman CT, Crawford AH, McMillion TL, Roy DR (1996) Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg 62(Suppl 1):41–50Google Scholar
  20. 20.
    Paradis G, Lavallee P, Gagnon N, Lemire L (1993) Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop Relat Res 297:231–237Google Scholar
  21. 21.
    Mubarak SJ (1985) Ischemia from fractures and injuries about the elbow. In: Morrey BF (ed) The elbow. Saunders, Philadelphia, pp 289–301Google Scholar
  22. 22.
    Weber BG, Brunner C, Freuler F, Casey PA (1981) Treatment of fractures in children and adolescents. J Pediatr Orthop 1:231–232.  https://doi.org/10.1097/01241398-198110000-00018 CrossRefGoogle Scholar
  23. 23.
    Kalanderer O, Reisoglu A, Sürer L (2007) AgusH.how should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures. Injury 76:253–256Google Scholar
  24. 24.
    Lyons JP, Ashley E, Hoffer MM (1998) Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop 18:43–45Google Scholar
  25. 25.
    Kazimoglu C, Çetin M, Şener M, Aguş H, Kalandere Ö (2009) Operative management of type III extension supracondylar fractures in children. Int Orthop SICOT33:1089–1094CrossRefGoogle Scholar
  26. 26.
    Cramer KE, Devito DP, Green NE (1992) Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. J Orthop Trauma 6:407–412CrossRefGoogle Scholar
  27. 27.
    Oh CW, Park BC, Kim PT, Park IH, Kyung HS, Ihn JC (2003) Completely displaced supracondylar humerus fractures in children: results of open reduction versus closed reduction. J Orthop Sci 8:137–141.  https://doi.org/10.1007/s007760300023 CrossRefGoogle Scholar
  28. 28.
    Sankar WN, Hebela NM, Skaggs DL, Flynn JM (2007) Loss of Pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am 89:713–717.  https://doi.org/10.2106/JBJS.F.00076 Google Scholar
  29. 29.
    Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM (2004) Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 86-A:702–707.  https://doi.org/10.2106/00004623-200404000-00006 CrossRefGoogle Scholar
  30. 30.
    Zionts LE, McKellop HA, Hathaway R (1994) Torsional Strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 76:253–256.  https://doi.org/10.2106/00004623-199402000-00013 CrossRefGoogle Scholar
  31. 31.
    Eidelman M, Hos N, Katzman A, Bialik V (2007) Prevention of ulnar nerve injury during fixation of supracondylar fractures in Children by ‘flexion-extension cross-pinning’ technique. J Pediatr Orthop 16:221–224.  https://doi.org/10.1097/BPB.0b013e328010b684 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of MedicineUniversity of BabylonBabilIraq
  2. 2.Department of Surgery, College of MedicineUniversity of BabylonBabilIraq

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