Comparison Between Closed Reduction and Percutaneous Fixation with K-Wires and Open Reduction and Internal Fixation in the Treatment of Supracondylar Fracture of the Humerus in Children
Prof. Dr. Ali Taha Hassan Al-Azzawi
Abstract
A study of (40) cases of supracondylar fracture of humerus in children with class (3) according to Gartland classification were done at Al-Hussein Teaching Hospital in Samawa city at the period from 1/9/2022 to 1/5/2023. A (26) male and (14) female, with mean age ( ), the extension type formed (35) cases, while the flexion type (5) cases. We applied closed reduction and percutaneous pin fixation for (20) cases under general anesthesia and imaging control, while the other (20) cases were treated with open reduction and internal fixation with K-wires. We compared between the two methods (CRPP) and (ORIF) according to Baumann's angle, carrying angle and loss of the motion. All the cases were sent for anteroposterior (AP) and lateral view of the elbow. This study showed that the (CRPP) method is better than the (ORIF) method in the treatment of this fracture. We study the sex, side of limb, the mechanism of fracture and the type of fracture. We followed up the patient at the first week and then every two weeks for three months.
References
1- Cheng JC, Shen WY: Limb fracture pattern in different pediatric age groups: a study of
3,350 children. J Orthop Trauma. 1993, 7:15-22. 10.1097/00005131-19930200000004.
2- McRae B, Nusem I: Temporal characteristics of paediatric supracondylar humerus
fractures. Trauma. 2018, 20:208-16. 10.1177/1460408617698511.
3- Skaggs D, Pershad J: Pediatric elbow trauma. Pediatr Emerg Care. 1997, 13:425-34.
10.1097/00006565-199712000-00021.
4- Holt JB, Glass NA, Shah AS: Understanding the epidemiology of pediatric
supracondylar humeral fractures in the United States: identifying opportunities for
intervention. J Pediatr Orthop. 2018, 38:e245-51. 10.1097/BPO.0000000000001154.
5- Shenoy PM, Islam A, Puri R: Current management of paediatric supracondylar fractures
of the humerus. Cureus. 2020, 12:e8137. 10.7759/cureus.8137.
6- Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB: Neurovascular injury and
displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995, 15:47-
52. 10.1097/01241398-199501000-00011.
7- Kzlay YO, Aktekin CN, Özsoy MH, Ak?ahin E, Sakao?ullar A, Pepe M, Kocadal O:
Gartland type 3 supracondylar humeral fractures in children: which open reduction
approach should be used after failed closed reduction?. J Orthop Trauma. 2017, 31:e18-
23. 10.1097/BOT.0000000000000681.
8- Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM: Does the modified Gartland
classification clarify decision making?. J Pediatr Orthop. 2018, 38:22-6.
10.1097/BPO.0000000000000741.
9- Gupta A, Singh M, Haq M: Results of open vs closed reduction and internal fixation of
type III supracondylar fractures. JK Sci. 2015, 17:135-7.
10- Bell P, Scannell BP, Loeffler BJ, et al.: Adolescent distal humerus fractures: ORIF versus
CRPP. J Pediatr Orthop. 2017, 37:511-20. 10.1097/BPO.0000000000000715.
11- Beaty JH, Kasser JR. Fractures about the elbow. Instr Course Lect. 1995;44:199– 215.
[PubMed] [Google Scholar].
12- Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry
compared with medial and lateral entry pin fixation for completely displaced
supracondylar humeral fractures in children. A randomized clinical trial. J Bone Jt
SurgAm. 2007;89(4):706–712.doi: 10.2106/JBJS.F.00379. [PubMed] [CrossRef]
[Google Scholar].
13- Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lalonde FD, Vitale MG,
et al. Delaying treatment of supracondylar fractures in children: has the pendulum swung
too far? J Bone Jt Surg Br. 2008;90(9):1228–1233. doi: 10.1302/0301-
620X.90B9.20728. [PubMed] [CrossRef] [Google Scholar].
14- Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial
and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the
humerus. JPediatrOrthop. 2007;27(2):181–186.
doi: 10.1097/bpo.0b013e3180316cf1. [PubMed] [CrossRef] [Google Scholar].
15- Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture stability
after pinning of displaced supracondylar distal humerus fractures in children. J Pediatr
Orthop. 2001;21(3):313–318. [PubMed] [Google Scholar].
16- Kalenderer O, Reisoglu A, Surer L, Agus H. How should one treat iatrogenic ulnar injury
after closed reduction and percutaneous pinning of paediatric supracondylar
humeralfractures? Injury. 2008;39(4):463–466.
doi: 10.1016/j.injury.2007.07.016. [PubMed] [CrossRef] [Google Scholar].
17- Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to
fix supracondylar fractures of the humerus in children. J Bone Jt Surg Am.
1994;76(2):253–256. [PubMed] [Google Scholar].
18- Shannon FJ, Mohan P, Chacko J, D’Souza LG. “Dorgan’s” percutaneous lateral
crosswiring of supracondylar fractures of the humerus in children. J Pediatr Orthop.
2004;24(4):376–379. doi: 10.1097/01241398-200407000-00006. [PubMed] [CrossRef]
[Google Scholar].
19- Weinberg AM, Castellani C, Arzdorf M, Schneider E, Gasser B, Linke B. Osteosynthesis
of supracondylar humerus fractures in children: a biomechanical comparison of four
techniques. Clin Biomech (Bristol, Avon) 2007;22(5):502–509. doi:
10.1016/j.clinbiomech.2006.12.004. [PubMed] [CrossRef] [Google Scholar].
20- Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the
management of supracondylar fractures in children. J Bone Jt Surg Am.
2004;86A(4):702–707. [PubMed] [Google Scholar].
3,350 children. J Orthop Trauma. 1993, 7:15-22. 10.1097/00005131-19930200000004.
2- McRae B, Nusem I: Temporal characteristics of paediatric supracondylar humerus
fractures. Trauma. 2018, 20:208-16. 10.1177/1460408617698511.
3- Skaggs D, Pershad J: Pediatric elbow trauma. Pediatr Emerg Care. 1997, 13:425-34.
10.1097/00006565-199712000-00021.
4- Holt JB, Glass NA, Shah AS: Understanding the epidemiology of pediatric
supracondylar humeral fractures in the United States: identifying opportunities for
intervention. J Pediatr Orthop. 2018, 38:e245-51. 10.1097/BPO.0000000000001154.
5- Shenoy PM, Islam A, Puri R: Current management of paediatric supracondylar fractures
of the humerus. Cureus. 2020, 12:e8137. 10.7759/cureus.8137.
6- Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB: Neurovascular injury and
displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995, 15:47-
52. 10.1097/01241398-199501000-00011.
7- Kzlay YO, Aktekin CN, Özsoy MH, Ak?ahin E, Sakao?ullar A, Pepe M, Kocadal O:
Gartland type 3 supracondylar humeral fractures in children: which open reduction
approach should be used after failed closed reduction?. J Orthop Trauma. 2017, 31:e18-
23. 10.1097/BOT.0000000000000681.
8- Leung S, Paryavi E, Herman MJ, Sponseller PD, Abzug JM: Does the modified Gartland
classification clarify decision making?. J Pediatr Orthop. 2018, 38:22-6.
10.1097/BPO.0000000000000741.
9- Gupta A, Singh M, Haq M: Results of open vs closed reduction and internal fixation of
type III supracondylar fractures. JK Sci. 2015, 17:135-7.
10- Bell P, Scannell BP, Loeffler BJ, et al.: Adolescent distal humerus fractures: ORIF versus
CRPP. J Pediatr Orthop. 2017, 37:511-20. 10.1097/BPO.0000000000000715.
11- Beaty JH, Kasser JR. Fractures about the elbow. Instr Course Lect. 1995;44:199– 215.
[PubMed] [Google Scholar].
12- Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry
compared with medial and lateral entry pin fixation for completely displaced
supracondylar humeral fractures in children. A randomized clinical trial. J Bone Jt
SurgAm. 2007;89(4):706–712.doi: 10.2106/JBJS.F.00379. [PubMed] [CrossRef]
[Google Scholar].
13- Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lalonde FD, Vitale MG,
et al. Delaying treatment of supracondylar fractures in children: has the pendulum swung
too far? J Bone Jt Surg Br. 2008;90(9):1228–1233. doi: 10.1302/0301-
620X.90B9.20728. [PubMed] [CrossRef] [Google Scholar].
14- Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial
and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the
humerus. JPediatrOrthop. 2007;27(2):181–186.
doi: 10.1097/bpo.0b013e3180316cf1. [PubMed] [CrossRef] [Google Scholar].
15- Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture stability
after pinning of displaced supracondylar distal humerus fractures in children. J Pediatr
Orthop. 2001;21(3):313–318. [PubMed] [Google Scholar].
16- Kalenderer O, Reisoglu A, Surer L, Agus H. How should one treat iatrogenic ulnar injury
after closed reduction and percutaneous pinning of paediatric supracondylar
humeralfractures? Injury. 2008;39(4):463–466.
doi: 10.1016/j.injury.2007.07.016. [PubMed] [CrossRef] [Google Scholar].
17- Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to
fix supracondylar fractures of the humerus in children. J Bone Jt Surg Am.
1994;76(2):253–256. [PubMed] [Google Scholar].
18- Shannon FJ, Mohan P, Chacko J, D’Souza LG. “Dorgan’s” percutaneous lateral
crosswiring of supracondylar fractures of the humerus in children. J Pediatr Orthop.
2004;24(4):376–379. doi: 10.1097/01241398-200407000-00006. [PubMed] [CrossRef]
[Google Scholar].
19- Weinberg AM, Castellani C, Arzdorf M, Schneider E, Gasser B, Linke B. Osteosynthesis
of supracondylar humerus fractures in children: a biomechanical comparison of four
techniques. Clin Biomech (Bristol, Avon) 2007;22(5):502–509. doi:
10.1016/j.clinbiomech.2006.12.004. [PubMed] [CrossRef] [Google Scholar].
20- Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the
management of supracondylar fractures in children. J Bone Jt Surg Am.
2004;86A(4):702–707. [PubMed] [Google Scholar].
