Skip to main content

Advertisement

SpringerLink
Log in

Treatment of displaced supracondylar humeral fractures in children by humero-ulnar external fixation

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Humero-ulnar external fixation has been proposed to treat complex supracondylar humeral fractures in children. It facilitates fracture reduction and reduces the risk of ulnar nerve lesion, which can occur after cross pinning.

Methods

In a ten year period, 28 children have been operated on in our centre by humero-ulnar external fixation, for Lagrange-Rigault stages III and IV supracondylar humeral fractures. The data about fracture management and early follow-up were obtained from our medical database. The long-term evaluation was done at a minimum six months’ follow-up. The range of motion and carrying angle measurements were classified according to Flynn. The final X-rays were evaluated for quality of reduction, presence of malunion, late infection signs, osteo-arthritis and myositis ossificans. The elbow function was evaluated by Mayo Elbow Performance Index (MEPI), Disabilities of the Arm, Shoulder and Hand (DASH) or modified DASH scores.

Results

The treatment was well tolerated by children and parents. There was no neurological complication related to the insertion of the pins, and no Volkmann syndrome. The median duration of external fixation was 33.5 days. Twelve patients were reviewed after a median follow-up duration of seven years (mean, 7.5 years; range, 3–21 years). One child had a refracture, three years after his original fracture, which was treated non-operatively. This case ended up in a cubitus varus deformity with a pronation deficit. All other patients had excellent clinical and radiological results.

Conclusions

For the treatment of complex supracondylar humeral fractures in children, humero-ulnar external fixation is a good alternative to lateral or crossed pinning. The advantages are the ease to obtain the reduction, the absence of neurological risk to the ulnar nerve and the possibility to obtain good stabilisation of the fracture with moderate elbow flexion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Omid R, Choi PD, Skaggs DL (2008) Supracondylar humeral fractures in children. J Bone Joint Surg Am 90:1121–1132

    Article  PubMed  Google Scholar 

  2. Bloom T, Robertson C, Mahar AT, Newton P (2008) Biomechanical analysis of supracondylar humerus fracture pinning for slightly malreduced fractures. J Pediatr Orthop 28:766–772

    Article  PubMed  Google Scholar 

  3. Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL (2001) Fracture stability after pinning of displaced supracondylar distal humerus fractures in children. J Pediatr Orthop 21:313–318

    CAS  PubMed  Google Scholar 

  4. Larson L, Firoozbakhsh K, Passarelli R, Bosch P (2006) Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop 26:573–578

    Article  PubMed  Google Scholar 

  5. Lee YH, Lee SK, Kim BS, Chung MS, Baek GH, Gong HS, Lee JK (2008) Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop 28:417–422

    Article  PubMed  Google Scholar 

  6. Mazda K, Boggione C, Fitoussi F, Penneçot GF (2001) Systematic pinning of displaced extension-type supracondylar fractures of the humerus in children. J Bone Surg Br 83:888–893

    Article  CAS  Google Scholar 

  7. Zamzam MM, Bakarman KA (2009) Treatment of displaced supracondylar humeral fractures among children : crossed versus lateral pinning. Injury 40:625–630

    Article  PubMed  Google Scholar 

  8. Zorrilla S, de Neira J, Prada-Cañizares A, Marti-Ciruelos R, Pretell-Mazzini J (2015) Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop 39:2287–2296

    Article  Google Scholar 

  9. Louahem DM, Nebunescu A, Canavese F, Dimeglio A (2006) Neurovascular complications and severe displacement in supracondylar humerus fractures in children: defensive or offensive strategy. J Pediatr Orthop B 15:51–57

    Article  PubMed  Google Scholar 

  10. Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K (2010) Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus : number needed to harm, a systematic review. J Pediatr Orthop 30:430–436

    Article  PubMed  Google Scholar 

  11. Gris M, Van Nieuwenhove O, Gehanne C, Quintin J, Burny F (2004) Treatment of supracondylar humeral fractures in children using external fixation. Orthopedics 27:1146–1150

    PubMed  Google Scholar 

  12. Quintin J, Schuind F (2011) Over thirty years of experience with Hoffmann® external fixation in paediatric orthopaedics and traumatology. Rev Med Brux 32:46–51

    Google Scholar 

  13. Slongo T, Schmid T, Wilkins K, Joeris A (2008) Lateral external fixation-a new surgical technique for displaced unreducible supracondylar humeral fractures in children. J Bone Joint Surg Am 90:1690–1697

    Article  PubMed  Google Scholar 

  14. Bahk MS, Srikumaran U, Ain MC, Erkula G, Leet AI, Sargent MC, Sponseller PD (2008) Patterns of pediatric supracondylar humerus fractures. J Pediatr Orthop 28:493–499

    Article  PubMed  Google Scholar 

  15. Barton KL, Kaminsky CK, Green DW, Shean CJ, Kautz SM, Skaggs DL (2001) Reliability of a modified Gartland classification of supracondylar humerus fractures. J Pediatr Orthop 21:27–30

    Article  CAS  PubMed  Google Scholar 

  16. de Gheldere A, Legname M, Leyder M, Mezzadri G, Docquier PL, Lascombes P (2010) Reliability of the Lagrange and Rigault classification system of supracondylar humerus extension fractures in children. Orthop Traumatol Surg Res 96:652–655

    Article  PubMed  Google Scholar 

  17. Lins RE, Simovitch RW, Waters PM (1999) Pediatric elbow trauma. Orthop Clin N Am 30:119–132

    Article  CAS  Google Scholar 

  18. Flynn JC, Matthews JG, Benoit RL (1974) Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 56:263–272

    CAS  PubMed  Google Scholar 

  19. Longo UG, Franceschi F, Loppini M, Maffulli N, Denaro V (2008) Rating system for evaluation of the elbow. Br Med Bull 87:131–161

    Article  PubMed  Google Scholar 

  20. Colović H, Stanković I, Dimitrijević L, Zivković V, Nikolić D (2008) The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children. Vojnosanit Pregl 65:27–32

    Article  PubMed  Google Scholar 

  21. Acton JD, McNally MA (2001) Baumann’s confusing legacy. Injury 32:41–43

    Article  CAS  PubMed  Google Scholar 

  22. Kazimoglu C, Cetin M, Sener M, Aguş H, Kalanderer O (2009) Operative management of type III extension supracondylar fractures in children. Int Orthop 33:1089–1094

    Article  PubMed  Google Scholar 

  23. De Boeck H (2003) Fracture de l’extrémité supérieure de l’humérus chez l’enfant. Encycl Med Chir (Editions Scientifiques et Medicales). Techniques chirurgicales-Orthopédie-Traumatologie, 44–324. Elsevier, Paris

  24. Kasser JR, Beaty JH (2006) Supracondylar fractures of the distal humerus. In: Rockwood & Wilkins’ Fractures in children, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 543–589

  25. Shrader MW (2008) Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin N Am 39:163–171

    Article  Google Scholar 

  26. Scannell BP, Jackson JB, Bray C, Roush TS, Brighton BK, Frick SL (2013) The perfused, pulseless supracondylar humeral fracture: intermediate-term follow-up of vascular status and function. J Bone Joint Surg Am 95:1913–1919

    Article  PubMed  Google Scholar 

  27. Battaglia TC, Armstrong DG, Schwend RM (2002) Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop 22:431–439

    PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  29. Worlock P (1986) Supracondylar fractures of the humerus. Assessment of cubitus varus by the Baumann angle. J Bone Joint Surg (Br) 68:755–757

    CAS  Google Scholar 

  30. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT (2001) Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am 83:735–740

    PubMed  Google Scholar 

  31. Green DW, Widmann RF, Frank JS, Gardner MJ (2005) Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma 19:158–163

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study has not received any financial form of support.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Erasme University Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium

    Aleksandra Bogdan, Jean Quintin & Frédéric Schuind

Authors
  1. Aleksandra Bogdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean Quintin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frédéric Schuind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frédéric Schuind.

Ethics declarations

Approval for this study was obtained from the Ethics Committee of Erasme Hospital, Brussels (ref. P2013/374; CCB, B406201318960).

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bogdan, A., Quintin, J. & Schuind, F. Treatment of displaced supracondylar humeral fractures in children by humero-ulnar external fixation. International Orthopaedics (SICOT) 40, 2409–2415 (2016). https://doi.org/10.1007/s00264-016-3251-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3251-y

Keywords

Search

Navigation