Abstract
Supracondylar fractures of the humerus in children are important for frequency and type of associated serious complications. The management of this kind of fractures is still controversial (Skaggs et al. in J Bone Joint Surg Am 86:702–707, 2004; Kalllio et al. in J Pediatr Orthop 12:11–15, 1992). We are going to present our experience in the treatment of supracondylar humeral fracture in children. In the Orthopedic Department of Pisa, we treated 150 cases from 1989 to 2006. We are used to perform, emergency or within 12 h, reduction and two lateral-entry percutaneous pins fixation. The mean age was 7.5 years. We checked 125 cases, because we excluded all the cases with follow up less then 5 years. The mean follow up was 8.2 years. We used Gartland classification modified by Wilkins. We evaluated 125 cases by using the Flynn classification: 100 % of patients did not have impairment of the elbow joint mobility. We had seven valgus deviation, one of which was more then 10°. We also had 17 varus deviations, 11 of which were not over 8° and only 2 of them were 15°. The average value of the joint Baumann angle was calculated as great as 16°. The obtained results were classified as very good 80 %, good 11 %, sufficiently good 6 %, and bad 3 %. In our experience, all the fractures type II and III by Gartland have to be treated within 12 h, with closed reduction and stabilization with lateral-entry K-wire technique. The conservative treatment by cast is indicated only in type I fracture. The trans olecranic treatment is not realizable, for the stiffness which can occur, for the risk of iatrogenic ulnar nerve lesion, and for long-time hospitalization. The open reduction remains the first choice treatment for exposed or nonreducible fractures, and in cases of vascular injury.
Similar content being viewed by others
References
Skaggs DL, Cluck MW et al (2004) Lateral entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 86:702–707
Kalllio PE, Foster BK et al (1992) Difficult supracondylar elbow fractures in children: analysis of percutaneous pinning technique. J Pediatr Orthop 12:11–15
Leitch KK, Kay RM et al (2006) Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified gartland type-IV fracture. J Bone Joint Surg Am 88:980–985
Farnsworth CL, Silva PD (1998) Etiology of supracondylar humerus fractures. J Pediatr Orthop 18:38–42
Campbell CC, Waters PM et al (1995) Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatric Orthop 15:47–52
De Sanctis N, Razzano E et al (1990) La paralisi del nervo interosseo anteriore (N.I.A.) possibile complicanza delle fratture sovracondiloidee omerali nell’infanzia. Rivista Italiana Ortopedia Pediatrica 8(2):379–382
Mubarak SJ, Carroll NC (1979) Volkmann’s contracture in children: aetiology and prevention. J Bone Joint Surg (Br) 61:285–293
Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet August:145–154
Ariño VL, Lluch EE, Ramirez AM, Ferrer J, Rodriguez L, Baixauli F (1977) Percutaneous fixation of supracondylar fractures of the humerus in children. J Bone Joint Surg 59-A:914–916
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
James AA, Richard JN (1977) Supracondylar fractures of the humerus. The role of dynamic factors in prevention of deformity. J Bone Joint Surg 350–355
Giannini S, Maffei G, Girolami M, Ceccarelli F (1983) Il trattamento delle fratture sovracondiloidee del bambino con riduzione e fissazione con fili di Kirschner percutanei. GIOT Fasc 2 183–192
Boyd DW, Aronson DD (1992) Supracondylar fractures of the humerus: a prospective study of percutaneous pinning. J Pediatr Orthop 12:789–794
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
De Pellegrini M, Brivio A, Pescatori E, Tessari L (2008) Supracondylar humerus fractures in children: closed reduction and cross pin fixation in prone position. GIOT 34:199–204
Pirone AM, Graham HK et al (1979) Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 61:425–428
Lyons JP, Ashley E et al (1998) Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbow. J Pediatr Orthop 18:43–45
Rasool MN (1998) Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 18(5):686–690
Wilkins KE (1991) Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, King RE (eds) Fractures in children, vol III. Lippincott, Philadelphia, p 593
Kocher MS, Kasser JR (2007) Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomizer clinical trial. J Bone Joint Surg Am 89:706–712
Ayadi K, Trigui M, Tounsi N, Ellouze Z, Bahloul L, Triki FE et al (2006) Supracondylar fractures of the humerus in children. Rev Chir Orthop 92:651–656
Larson L, Firoozbakhsh K (2006) Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop 26(5) Sep–Oct
Epps CH, Bowen R (1995) Complication in pediatric orthopaedic surgery. Philadelpjia, JB Lippincott
Mastragostino S, Stella G (1990) L’urgenza nelle fratture sovracondiloidee di omero nei bambini. Rivista Italiana Ortopedia e Traumatologia Pediatrica 280–284
Odgen JA (1990) Skeletal injury in the child. WB Saunders, Philadelphia
Gupta N, Kay RM et al (2004) Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children. J Pediatr Orthop 24(3):245–248
Sutton WR, Greene WB, Georgeopoulos G, Dameron TB Jr (1992) Displaced supracondylar fractures in children. A comparison of results and costs in patients treated by skeletal traction versus percutaneous pinning. Ciln Orthop 278:81–87
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scaglione, M., Giovannelli, D., Fabbri, L. et al. Supracondylar humerus fractures in children treated with closed reduction and percutaneous pinning. Musculoskelet Surg 96, 111–116 (2012). https://doi.org/10.1007/s12306-012-0204-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-012-0204-5