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ObjectiveTo observe the therapeutic effect of early postoperative comprehensive rehabilitation on elbow joint dysfunction and ulnar nerve injury in children and adolecents with supracondylar fracture of humerus complicated with ulnar nerve injury. MethodsA total of 49 children with supracondylar fracture of humerus complicated with ulnar nerve injury after operation were selected from January, 2016 to December, 2021 in Wangjing Hospital, which were randomly divided into control group (n = 24) and treatment group (n = 25). The control group accepted wax therapy and acupuncture, and the treatment group accepted medicine fumigation, joint mobilization and electromyographic biofeedback, for twelve weeks. They were assessed with The Hospital for Special Surgery Elbow score (HSS) and Medical Research Neurotrauma Society Report (MCRR) before and after treatment. ResultsAfter treatent, the HSS scores increased in both groups (|t| > 8.345, P < 0.001). The HSS score was significantly higher in the treatment group than in the control group (t = 4.536, P < 0.001). The d-value of HSS scores before and after treatment was significantly higher in the treatment group than in the control group (t = 3.717, P < 0.05). The rate of excellent recovery of ulnar nerve function was significantly higher in the treatment group than in the control group (χ2 = 5.975, P < 0.05). ConclusionEarly postoperative comprehensive rehabilitation could romote the recovery of elbow function and ulnar nerve injury in children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury.
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Resumen Objetivo: Analizar los resultados de la técnica quirúrgica de colocación de clavillos Kirschner forma lateral versus cruzada en el manejo de las fracturas supracondíleas de húmero en pacientes pediátricos. Metodología: Se captaron a todos los pacientes con fractura supracondílea humeral en edad pediátrica que requirieron intervención quirúrgica, y posteriormente fueron evaluados a las 24 horas y 6 meses posterior al tratamiento quirúrgico para observar y comparar las diferencias entre cada técnica quirúrgica utilizada, tomando en cuenta las complicaciones agudas y tardías que se presentaron mediante un análisis con la prueba de Mann-Whitney. Resultados: Para el presente estudios se evaluaron 44 pacientes pediátricos de los cuales 70% eran hombres y 30% mujeres, en quienes se presentaron complicaciones nerviosas y angulares sin importancia significativa alguna con el sexo y edades de los pacientes, siendo la afección del nervio cubital la de mayor frecuencia con 33% en la colocación de forma cruzada. Al realizar la comparativa con discriminación de variables se obtiene que la colocación de forma lateral presenta menos complicaciones posquirúrgicas tempranas y tardías y que tales no se deben al azar. Limitaciones o implicaciones: En el presente estudio no se incluyó el tipo de daño mecánico que provoca este tipo de fractura, ni se consideró el ángulo de Baumann. Otra limitación inherente en la población pediátrica es la habilidad del explorador para detectar un déficit neurológico, especialmente en pacientes de edad temprana dado a que los reportes de una exploración física siempre son subjetivos. Además, dada la limitación en cuanto a los detalles del mecanismo específico de daño, se puede subestimar el número de daños provocados por mecanismos de alta energía. Originalidad y valor: Su importancia radica en que ambas técnicas quirúrgicas fueron realizadas por los mismos cirujanos y que se trata de un estudio en población mexicana, siendo un aporte para la literatura de este país. Conclusión: Ambas técnicas quirúrgicas presentan resultados posquirúrgicos con casos de lesión nerviosa, deformidad angular, dolor y edema persistente, pero la que los presenta en menor frecuencia es la técnica de colocación de clavillos Kirschner en forma lateral, además de causar una significancia estadística en cuanto a la disminución de presentar cubito valgo en el seguimiento tardío de los pacientes.
Abstract: Objective: To analyze the results of the surgical technique placement of Kirschner pins lateral versus crossed in the management of supracondylar fractures of the humerus in pediatric patients. Methodology: All pediatric patients with humeral supracondylar fracture who required surgical intervention and were subsequently evaluated 24 hours and 6 months after surgical treatment to observe and compare the differences between each patient. surgical technique used. Taking into account the acute and late complications that occurred, through an analysis with the Mann-Whitney test. Results: For the present studies, 44 pediatric patients were evaluated, of whom 70% were men and 30% women, in whom nerve and angular complications presented without any significant importance with the sex and age of the patients, with ulnar nerve involvement being the most frequent with 33% in cross placement. When carrying out the comparison with discrimination of variables, it is obtained that the placement laterally presents fewer early and late post-surgical complications and that such are not due to chance. Or the present study, it is considered that a placement of Kirschner pins laterally regardless of the member, age, gender or classification; leads to better post-surgical results. Limitations or implications: In the present study, the type of mechanical damage that causes this type of fracture was not included, nor was the Baumann angle considered. Another limitation inherent in the pediatric population is the ability of the examiner to detect a neurological deficit, especially in young patients since reports of a physical examination are always subjective. Furthermore, given the limited details of the specific damage mechanism, the number of damages caused by high-energy mechanisms may be underestimated. Originality or value: Its importance lies in the fact that both surgical techniques were performed by the same surgeons and that it is a study in the mexican population, being a contribution to the literature of this country. Findings or conclusions: Both surgical techniques present post-surgical results with cases of nerve injury, angular deformity, pain and persistent edema, but the one that presents them less frequently in the technique of placement of Kirschner pins laterally, in addition to causing statistical significance in terms of the decrease of presenting cubitus valgus in the late follow-up of the patients.
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Objective To investigate the efficacy of using the extensor carpi ulnaris as the motor tendon in correcting claw hand deformity and improving hand function.Methods A total of 12 patients with ulnar nerve palsy and claw finger deformity were included into this study from October, 2009 to September, 2011.Results All ceses had an average followed-up of 15.5 months, ranging from 12 months to 24 months.According to the Total Active Movement (TAM) score, there were 4 cases receiving excellent results, 6 cases receiving good results and 2 cases receiving fair results.The claw finger deformity was corrected and intrinsic hand function improved significantly.The average increase in grip strength was 41％ at the 12 months post operation, compared with the preoperative data (P ＜ 0.05).The mean DASH score decreased from 53.6 ± 11.4 preoperatively to 20.4 ± 6.8 postoperatively (P ＜ 0.05).Conclusion The technique of using the extensor carpi ulnaris as the motor tendon is effective in correcting claw fingers, increasing the grip strength and improving overall hand function.This surgical procedure is also beneficial for patients accompanied by the median nerve injury.
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The percutaneous pinning is a simple, effective method for the treatment of displaced supracondylar fractures of the humerus in children. But there is some controversy in the number of pins used and the method of pin insertion. The cross pinning method provides more stability at the fracture site but the risk of ulnar nerve damage is higher than in lateral pinning method, The senenty-one displaced extension type supracondylar fractures were treated by closed reduction and percutaneous cross pinning from January 1991 to October 1994. Among them, the medial pin was inserted in elbow extension in twenty-eight cases and in forty- three cases the medial pin was inserted in elbow flexion. Ulnar nerve injury occured postoperatively in six cases, in which the pin was inserted with the elbow in flexion position. These results may suggest that when percutaneous cross pinning method is selected to fix the supracondylar fracture of the humerus, it would be safer to insert one or two lateral pins with the elbow in full flexion position followed by one medial pin in extension position in order to reduce the risk of loss of reduction and ulnar nerve damage.