Title: Role of Closed Reduction & Internal Fixation in Supracondylar Fractures of the Humerus

Authors: Dr Mayank Shukla, Dr Amrta Tiwari, Dr Deepak Kumar

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i6.11

Abstract

Background: Displaced supracondylar fractures have a high rate of displacement and if not reduced and stabilized in optimal position may lead to serious residual deformity. No general agreement on the treatment is evident with controversy prevailing regarding the ideal timing of surgery, method of maintenance of reduction and configuration of the pin fixation.

Materials And Methods: Twenty Four  males and Eight females with ages ranging from 3-12 years who required closed reduction and internal fixation using percutaneous Kirschner wire for fresh displaced supracondylar fractures of humerus between March 2012 -Dce 2015 were selected. The Kirschner wires were passed percutaneously under C-Arm control from the lateral epicondyle in varying geometry or configuration to achieve fracture stability. Each patient was followed up for at least one years and results were graded using the Flynn’s criteria. They were graded as excellent in 28 (87.50%) cases, good in 03(09.38%) cases and only 01 (03.12%) case had a poor result, there were no fair results at the end of final follow up.

Conclusion: Treatment of the supracondylar humeral fracture in children by closed reduction and internal fixation is a safe approach with predictable good clinical and radiographical results.

Key-words: Anatomical reduction, Percutaneous Fixation, Baumann’s angle, Humerus supracondylar fracture and closed reduction. 

References

    

1.      Wilkins KE. The operative management of supracondylar fractures. Orthop Clin North Am 1990;21:269‑89.

2.      Eid AM.Reduction of displaced supracondylar fracture of the humerus in children by manipulation in flexion. Acta Orthop Scand.1978 Feb ; 49 (1) : 39-45

3.      Archibeck MJ, Scott SM, Peters CL. Brachialis muscle entrapment in displaced supracondylar humeral fracture: a technique of close reduction and report of initial result. J Pediatr Orthop.1997; 298-302.

4.      Peters CL, Scott SM, Stevens PM.Close reduction and percutaneous pinning of displaced supracondylar humeral fracture in children:description of a new closed reduction technique of fracture with brachialis muscle entrapment. J Orthop Trauma. 1995 ; 9: 430-434.

5.      Chen RS, Liu CB, Lin XS, Feng XM, Zhu JM, Ye FQ.Supracondylar extension fracture of the humerus in children , manipulative rduction,immobilization and fixation using a U-shaped plaster slab with elbow in full extension.J Bone Joint Surg (Br).2001 Aug; 83(6): 883-7.

6.      Wilkins KE.The management of severily displaced supracondylar fractures of the humerus. Techniques Orthop.1989; 4:5-24.

7.      Lee SS, Mahar AT, Miesen D, Newton PO.Displaced pediatric supracondylar humerus fracture: biomechanical analysis of percutaneous pinning. J Pediatr Orthop.2002; 22 (4) : 440-3.

8.      Zionts LE, McKellop HA, Hathway R.Torsional strength of pin configuration used to fix supracondylar humerus fracture in children.J Bone Joint Surg (Am).1994; 76: 253-256.

9.      Topping RE, Blanco JS, Davis TJ:Clinical evaluation of crossed pin versus lateral pin fixation of the displaced supracondylar humeral fracture. J Pediatr Orthop1995; 15: 435-439.

10.  Aronson DD, Prager BI. Supracondylar fracture of the humerus in children. A modified technique of closed pinning. Clin Orthop 1985; 15: 174-184

11.  Arino VL, Lluch EE, Ramirez AM, Ferrer J, Rodriguez L, BaixanliF. Percutaneous fixation of supracondylar fracture of the humerus in children. J Bone Joint Surg [Am] 1977; 56-A: 1914-1916.

12.  Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the Humerus in the children. J Bone Joint Surg [Am] 1974; 16-A; 262-272.

Corresponding Author

Dr Mayank Shukla

Qtr. No 102 Staff Accom. Ist , Rama Medical College, Mandhana Kanpur