Outcome of close reduction and percutaneous pinning in displaced pediatric supracondylar fracture of humerus assessed by Flynn's criteria

To evaluate the adequacy of closed reduction and percutaneous Kirschner [K]-wire fixation technique in treatment of unstable type II and III supracondylar humeral fractures in children by Flynn's Criteria. A descriptive study. Combined Military Hospital / Military Hospital Rawalpindi, from August 2008 to September 2012 Children with displaced type II and III supracondylar fractures of the humerus who were managed with closed reduction and percutaneous K-wire fixation were included. All patients were operated upon within three days after trauma. Patients were followed up for a mean period of 4 +/- 1 months and assessed radiologically for union. Functionally and cosmetically they were assessed according to Flynn's criteria. Eighty nine children with displaced type II and III supracondylar fractures of the humerus were managed with closed reduction and percutaneous K-wire fixation. There were 67 boys and 22 girls with a mean age of 7.2 +/- 2.07 year. All patients achieved solid union. Functionally, 94.4% patients achieved excellent and good while 4.5% had satisfactory results. Cosmetically 86.5% of patients had excellent and good results, 5.6% satisfactory and 7.9% had unsatisfactory results. The most frequent complication was minor pin tract infection in seven patients. Two patients had neuraprexia of ulnar nerve after pinning. The obtained results and few complications noted suggest that the technique is a suitable treatment option for displaced type II and III supracondylar fractures in children, if referred early

Closed reduction and pop immobilization for colles' fracture under haematoma block and sedation as a day care

To access the radiological and clinical outcome of closed reduction and cast immobilization for Colles' fracture under haematoma block and sedation. A quasi experimental study. CMH Rawalpindi from August 2009 to November 2010. Fifty five patients were enrolled in our study. We used Lignocaine plain for haematoma block, Nalbupline and Midazolam for sedation. Closed reduction was done with standard technique. Post operative x-rays were evaluated for length of radius and angulation, palmar tilt and articular congruity. Follow up x -rays were conducted every week for three weeks and then at six weeks. Above elbow plaster of Paris [POP] was converted to below elbow at three weeks. Cast was removed at six weeks. After removal of the cast range of movement at wrist, joint pain and grip strength was checked. Good radiological reduction was achieved using this method. Radius length was within 6 -13 mm [mean 10.4 +/- 2.1], angulation was between 13[0] -23[0] [mean 20.1 +/- 2.6], palmar tilt wsa between 1[0]-5[0] in 54 patients. One patient had dorsal tilt and required revision. In patients with intra articular extension, the intra-articular step was less than 1 mm in 53 patients. Two patients had more than 2 mm intra articular step that required revision. Our functional results were acceptable. Excellent pain relief was seen in 94.5% cases as assessed by visual analogue scale. Grip strength was excellent in 45 [81.8%], good in 9 [16.4%] and fair in 1 [1.8%] patient. We achieved near normal range of movement at wrist. Closed reduction and pop immobilization for Colles' fracture under haematoma block and sedation is a good treatment option in carefully selected cases.