ABSTRACT
OBJECTIVE@#To investigate the effectiveness of medial and lateral column periosteal hinge reconstruction using Kirschner wire in the closed reduction of multi-directional unstable humeral supracondylar fractures in children.@*METHODS@#A clinical data of 43 children with multi-direction unstable humeral supracondylar fractures, who met the selection criteria and were admitted between August 2020 and August 2022, was retrospectively analyzed. Twenty-one cases of fractures were treated wuth closed reduction after medial and lateral column periosteal hinge reconstruction using Kirschner wire and percutaneous Kirschner wires fixation (study group), while 22 cases of fractures were treated by traditional closed reduction technique and percutaneous Kirschner wire fixation (control group). There was no significant difference in gender, age, cause of injury, fracture side, and interval from injury to operation between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, the number of children who were changed to open reduction after closed reduction failure, fracture healing time, complications within 2 months after operation, and the Flynn score of elbow joint function at last follow-up were compared between the two groups.@*RESULTS@#All the fractures in the study group were successfully closed reduction, and 4 cases in the control group were changed to open reduction and completed the operation, the difference between the two groups was significant ( P=0.040). The operation time and intraoperative fluoroscopy times of the study group were significantly less than those of the control group ( P<0.05). All children in both groups were followed up 6-18 months with an average of 9.0 months in the study group and 9.8 months in the control group. Imaging review showed that the fractures of both groups healed, and the difference in the healing time between the two groups was not significant ( P=0.373). According to Flynn score at last follow-up, the excellent and good rate of elbow joint function was 95.2% (20/21) in the study group and 86.4% (19/22) in the control group, with no significant difference ( P=0.317). There was no complication such as infection or irritation at the end of Kirchner wire within 2 months after operation.@*CONCLUSION@#For children with multi-directional unstable humeral supracondylar fractures, the use of Kirschner wires to reconstruct the medial and lateral column periosteal hinge to assist in closed reduction has the advantages of shortening operation time, reducing intraoperative fluoroscopy times, and effectively reducing the incidence of open reduction, and can achieve similar postoperative elbow joint function when compared with traditional closed reduction technique.
Subject(s)
Humans , Child , Bone Wires , Retrospective Studies , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Humerus/surgery , Treatment OutcomeABSTRACT
Objective:To investigate the treatment strategy for pediatric humeral supracondylar fractures with callus formation and displacement neglected for over 1 week.Methods:A retrospective analysis was made of the clinical data of 36 children who had been treated at Department of Pediatric Orthopaedics, Medical Center, The Second Affiliated Hospital, Inner Mongolia Medical University from January 2011 to January 2021 for humeral supracondylar fractures with callus formation and displacement neglected for over 1 week. There were 22 boys and 14 girls, with an age of (6.7±2.7) years (from 2.3 to 12.8 years). All fractures were Gartland type Ⅲ. The patients were divided into 2 groups according to their treatment methods: a closed reduction and percutaneous pinning (CRPP) group of 15 patients subjected to the CRPP treatment only, and a leverage group of 21 patients subjected to CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling. The 2 groups were compared in terms of operation time, fluoroscopy frequency, quality of reduction, and recovery time for elbow range of motion; the elbow range of motion, visual analogue scale (VAS), Mayo elbow performance score (MEPS) and complications were assessed at the last follow-up.Results:The 2 groups were comparable because there was no significant difference between them in the general information before operation ( P>0.05). All patients were followed up for (26.2±16.3) months (from 6 to 96 months). All the fractures obtained acceptable reduction and clinical union 4 to 6 weeks after operation. The operation time [(28.2±6.8) min] and fluoroscopy frequency [(27.0±6.0) times] in the leverage group were significantly less than those in the CRPP group [(40.8±10.8) min and (43.3±11.4) times] ( P<0.05). The CRPP group was significantly better than the leverage group in the intraoperative Baumann angle (78.1°±1.6° versus 73.7°±4.1°), lateral capitellohumeral angle (58.3°±2.6° versus 49.6°±5.2°) and horizontal rotation rate (109.5%±3.0% versus 103.2%±4.9%) ( P<0.05). The intraoperative reduction in the CRPP group was significantly closer to the normal mean value than that in the leverage group ( P<0.05). There was no significant difference in the recovery time for elbow range of motion between the CRPP and the leverage groups ( P>0.05). At the last follow-up, the Baumann angle (75.4°±2.8°) and the lateral capitellohumeral angle (53.2°±3.6°) in the leverage group were still significantly better than those in the CRPP group (78.3°±1.5° and 57.5°±2.3°) ( P<0.05). However, there was no significant difference in the elbow range of motion, VAS, MEPS or incidence of complications between the 2 groups ( P>0.05). Conclusion:To treat humeral supracondylar fractures with callus formation and displacement neglected for over 1 week in children, CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling is an efficient and accurate method, because it can lead to more satisfactory reduction than CRPP only.
ABSTRACT
Objective To investigate the curative efficacy of fracture with closed reduction and percutaneous Kirschner wire fixation of the simple lateral injury for humeral supracondylar fracture of Gartland type Ⅱ and type Ⅲ in children by the emergency treatment and selective surgery. Methods From March 2010 to March 2012,sixty children with Gartland type Ⅱ and type Ⅲ fresh humeral supracondylar fracture were operated in Xianyang Center Hospital. Six-ty children were randomly divided into two groups:group A by emergency operation 8 hours after injury with closed re-duction method and lateral percutaneous Kirschner wire fixation only,group B initially treated with plast fixation,then undergoing surgery after 3 - 5 days of injury with the closed reduction and percutaneous pin fixation. The operation du-ration,frequency of intraoperative image intensifier,postoperative swelling,pain lasting time after injury and hospitaliza-tion cost were investigated in two groups. Results The average operation duration of group A was(18. 5 ± 12. 3)min, and that in group B was(20. 1 ± 15. 3)min,and there was a statistically significant difference between two groups(P ﹤0. 05). The frequency of intraoperative image intensifier was 6. 2 times on the average in group A,but 7. 3 times in group B,and there was a statistically significant difference between two groups(P ﹤ 0. 05). The postoperative swelling rate on 3,5,7 days after injury in group B was significantly higher than that of group A,and there was a statistically sig-nificant difference(all P ﹤ 0. 05). The duration of pain after injury in group A was(3. 44 ± 1. 23)days,but(5. 26 ± 1. 36)days in group B,which was significantly different;the nerve function recovery time of group A was(36. 5 ± 7. 0) d,and it was(36. 2 ± 7. 0)d in group B,which was not significantly different(P ﹥ 0. 05). The average hospitalization time and cost in group A was less than that in group B,which was significantly different(P ﹤ 0. 05). Finally there was no statistically significant difference in elbow joint function between two groups of children(P ﹥ 0. 05). Conclusions The emergency operation of closed reduction and percutaneous Kirschner wire fixation for the treatment of simple lateral injury in children with Gartland type Ⅱ and type Ⅲ fracture has the advantages over the selective surgery,including shorter operation time,less contact of X - ray intraoperatively,light postoperative swelling,short duration of pain in chil-dren,as well as the shortened hospitalization time,reduced costs,especially good efficacy for joint function recovery.
ABSTRACT
Objective To explore the effects of comprehensive rehabilitation on elbow joint dysfunction in preschool children with hu-meral supracondylar fracture. Methods 16 cases of humeral supracondylar fracture with elbow joint dysfunction were treated with fumiga-tion of Chinese medicine combined with manipulation and physical therapy. The range of motion (ROM) and Hospital for Special Surgery Scoring System (HSS2) were used to evaluate the effects of treatment. Results ROM of elbow joint improved significantly after treatment (P<0.001), and all the children reachedexcellenceafter treatment according to HSS2. Conclusion Comprehensive rehabilitation is effec-tive on elbow joint dysfunction in preschool children with humeral supracondylar fracture.
ABSTRACT
Objective To explore the clinical results and complications of the traditional skeletal traction through olecranon on treating the irreducible humeral supracondylar fracture in children with of ulna.Methods Ninety-eight children patients of humeral supracondylar fracture with failure of reduction manipulation were selected as our subjects.The towel clamp-skeletal traction through olecranon of ulna was applied as the additional treatment methods.Meanwhile 5-24 months' follow-up were performed.Results According to Flynn elbow joint function evaluation standard.The curative effect was as followed.71 patients (74.7％) got the excellent outcome,17 patients (17.9％) for good outcome and 7 patients for improved utcome(7.3％).Therefore,the ratio of excellent operation reached to 92.6％.Conclusion The towel clampskeletal traction through olecranon of ulna might be an effective method to treat reliable fixation regarding of its high curing rate and simple process of performance.
ABSTRACT
Objective To observe the clinical effect of treating humeral supracondylar fracture in children with manual reduction combined with oral medicinal herbs and fumigation.Methods 80 children with humeral supracondylar fracture were involved in clinical observation.Patients with Gartland Type Ⅰ and Type Ⅱ were selected and treated with manual reduction and plaster external fixation.Gartland Type Ⅲ cases were selected and treated with Kirschner-wire transfixion.All of patients were treated with oral medicinal herbs and fumigation.Results All children with humeral supracondylar fracture recovered.Based on the clinical function test,39(48.75%)cases had excellent effects,39(48.75%)cases had good effects,and 2(2.50%)cases had fair effects.No Volkmann contracture or cubitus varus deformity occurred.Conclusion The treatment of humeral supracondylar fracture in children with manual reduction combined with oral medicinal herbs and fumigation has a good effect.
ABSTRACT
Objective To analyze the clinical therapeutic effect of close reduction and perculaneous Kirschner wire fixation in treating humeral supracondylar fracture in children.Methods We retrospectively analyzed 28 children who had humeral supracondylar fracture treater in our department from January 2006 to December 2008.They were 2 to 13 years old (mena age:7 years and 5 months). According to Garland typing ,3 children had type I fracture ,11 type II and 14 type III. Closed reduction was performed guided by C-arm X-ray machine. Then the fracture was perculaneously fixed with 2 or 3 Kirschner wires of 1.5mm,and the elbow and wrist joints were fixed in the functional position with upper limb plaster.Results All patients were followed up for average 4~12months. All patients obtained bone union. No Volkmann contracture os iatrogenic nerve injury occurred. Conclusion Close reduction and percutaneous Kirschner wires fixation for humeral supracondylar fracture in children has the advantages of small injury and stable bone fixation.In addition,it can prevent Volkmann contracture and achieve good elbow joint function recovery.
ABSTRACT
0.05).The cubitus varus incidence evaluation was done by follow-up study,2 cases were in operation group and 8 cases in non-operation group,there was a significant difference between the 2 groups(P