Details
Category: Volume 05 Issue 11 November 2017
Hits: 1510

Title: Management of Type-A Extra-articular Supracondylar Fracture Humerus using various Treatment Modalities

Authors: Amandeep Singh Bakshi, Ashish Garg, Bhupinder Singh Brar, Daljinder Singh, Satbir Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.19

Abstract

Introduction: Supracondylar Fractures of humerus in adults have traditionally presented a treatment challenge for the orthopedic surgeons. The combination of anatomic complexity, multifragmentary comminution, and a short distal segment, often in the setting of osteoporotic bone, renders these fractures difficult to treat successfully and often make a full restoration of function uncertain.1The objective of the current study was to evaluate and compare various treatment modalities used in the management of Type-A Extraarticular Supracondylar Fracture of  Humerus.

Material and Methods: This randomized, interventional study was conducted on 30 patients of Type-A Extraarticular Supracondylar Fracture of  Humerus using various treatment modalities with following aims and objectives:-

  1. To achieve stable internal fixation.
  2. To study the functional outcome of the patient by assessing union rate, range of movement.
  3. To assess specific and general complications encountered with the procedure, if any.

Results: Patients were followed up at regular intervals (3 weeks, 6 weeks, 12 weeks and 6 months) for any complications, requirement of analgesics and physiotherapy. Fracture union was assessed clinically and radiologically. Elbow function on the operated side was evaluated and compared with the normal side as per Mayo elbow score.2 Results were analysed statistically using chi-square test and ANOVA test.

Conclusion: The best treatment modality in our study was Bicolumn fixation with dual plating in adults as it provides more rigid fixation than a single LCP. Fracture types in which anatomy can be restored properly, precontured plates were used and Fractures in which anatomical reduction was not possible, Reconstruction plates were used for bicolumn fixation. Attaining correct alignment, rotation, and length without disrupting the soft tissue attachments to the communited fragments often leads to successful healing.

Keywords: Type-A Extraarticular Supracondylar Fracture Humerus, various treatment modalities, Bicolumn Fixation, Mayo Elbow Score.

References

  1. Jones RW. Fractures and joint injuries. 4th ed. Vol. II. Edinburgh: E & S Livingstone Ltd, 1955
  2. Arnold JA, Nasca RJ and  Nelson CL. Supracondylar fractures of the humerus: the role of dynamic factors in prevention of deformity. J Bone Joint Surg Am. 1977; 59 (5):589 -595.
  3. Robinson CM, Hill RM, Jacobs N, et al. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003; 17(1):38–47
  4. Korner J, Lill H, Müller LP, et al. The LCP-concept in the operative treatment of distal humerus fractures: biological,
    biomechanical and surgical aspects. Injury 2003;34 (Suppl 2):20–30.
  5. Henley MB: lntraarticular distal Humeral fractures in adults: Orthop. Gun. North Am. 18(1):11-23,1987
  6. Cassabeum WH: Operative treatment of T and Y fractures of the lower end of Humerus: Am. J Surg. 83:265-270,1952
  7. Diana JN, Ramsay MD: Decision making in complex fractures of the distal Humerus: Univ. Penny. Orthop. J.,1998.
  8. Rockwood CA, Green DP: Fractures in adults, Philadelphia: J.B. Lippincott Co., Ed. HI, Vol. 1:752-761,1996.
  9. Athwal GS. Distal Humerus Fractures In: Rockwood & Green’s Fractures In 7th ed. Philadelphia:Lippincott Williams & Wilkins ; 2010; 1: 945-946.
  10. Holdsworth BJ (1989) Planning in fracture surgery. In: Bunker TD, Colton CL, Webb JK, editors. Frontiers in Fracture Manage-ment. London: Martin Dunitz: 1–15
  11. Riseborough EJ, Radin EL. Intercondylar T fractures of Humerus in adults: J Bone Joint Surg. 1969; 51-A: 130-141.
  12. Mueller ME, Nazarian S, Koch P and Schatzker J. Comprehensive classification of fractures of long bones. Berlin: Springer-Verlag; 1990.
  13. Lagrange J and Rigault P. Fractures supra-condyliennes. Revue de chirurgie orthopedique et reparatrice de l’ appareilmoteur. 1962; 48, 337-446.
  14. Zagorski et al: Comminuted intraarticular fractures of the distal Humeral condyles: Clin. Orthop. 202:197-205,1986
  15. Brown R, Morgan R. Intercondylar T-shaped fractures of the humerus.J Bone Jt Surg. 1971;53B:425–428.
  16. Evans EM. Supracondylar Y-fractures of the humerus. J Bone JointSurg [Br]. 1953; 35-B: 381-5.

Corresponding Author

Ashish Garg

Department of Orthopaedics, Government Medical College,

Patiala, Punjab, India 147001