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Objective:To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children.Methods:The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins type Ⅲ from January 2013 to December 2021 at Department of Orthopaedics, Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital. They were divided into a reduction failure group (35 cases) and a reduction success group (136 cases). Factors such as fracture height, age, body mass index, ulnar-radial offset direction, obvious axial rotation of the distal fracture fragment, combined ulnar nerve injury, and time from injury to operation were listed as risk factors. The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results:The average age of 171 children was (7.8±2.6) years. There were 151 cases of radial deviation and 20 cases of ulnar deviation, 120 high type fractures and 51 low type fractures, and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment. The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age, obvious rotation of the distal fracture fragment, and ulnar nerve injury ( P<0.05), but no significant differences in fracture height, body mass index, ulnar-radial offset direction, or time from injury to operation ( P>0.05). Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment ( OR=3.287, 95% CI: 1.136 to 9.513, P=0.028) and combined ulnar nerve injury ( OR=6.439, 95% CI: 2.262 to 18.327, P=0.001) were risk factors for failure in closed reduction. Conclusion:As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children, they should arouse more attention in the treatment of such fractures.
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Objective:To compare the effects of the fracture line direction in the sagittal profile on the Gartland type Ⅲ supracondylar humerus fractures in children.Methods:A total of 153 cases of Gartland type Ⅲ supracondylar humerus fractures treated in the Department of Pediatric Orthopedics, Qilu Hospital of Shandong University (Qingdao) from January 2017 to April 2019 were retrospectively analyzed.They were categorized into the traditional oblique type (the fracture line went downward in the front and upward in the back), transverse type (the fracture line went horizontally) and reverse oblique type (the fracture line went upward in the front and downward in the back). Gender, age, injury side, cause of injury, ecchymosis before elbow, preoperative neurological symptoms, operation time, incision ratio, and Flynn scores of the elbow joint at the last follow-up were compared among the 3 groups.Results:Patients were followed up for (8.65±2.47) months (6-15 months). There were 60, 64 and 29 patients in the traditional oblique type, transverse type and reserve oblique type groups, respectively.There were no differences in the gender, injury side, and injury causes among the 3 groups (all P>0.05). The age of the traditional oblique type, transverse type and reverse oblique type group were (4.76±2.51) years, (4.71±2.09) years and (6.32±1.98) years, respectively, which was significant different among the 3 groups ( F=5.826, P<0.05). There were 10, 7 and 11 cases of preoperative elbow ecchymosis occurred in children of the traditional oblique type, transverse type and reverse oblique type groups, respectively, which was significant different ( χ2=9.902, P<0.05). No significant differences were found in preoperative neurological symptoms of the 3 groups ( P>0.05). The operative time for the traditional oblique type, transverse type and reverse oblique type group were (43.28±24.25) min, (40.95±27.41) min and (58.66±34.08) min, which was significant different ( F=4.337, P<0.05). The traditional oblique type and transverse type groups had 1 failure case of closed reduction, respectively, and the incision was performed during the operation.There were 4 cases in the reverse oblique type group who underwent the open reduction.The reduction rate was significantly different among 3 groups ( χ2=6.883, P<0.05). There was no significant difference in the excellent to good rate of traditional oblique type (96.67%, 58/60 cases), transverse type(95.31%, 61/64 cases)and reserve oblique type (93.10%, 27/29 cases) among 3 groups ( P>0.05). Conclusions:The reverse oblique Gartland type Ⅲ supracondylar humerus fractures are relatively rare in clinical practice, which involves more severe soft tissue damages and more obvious antecubital ecchymosis.The conventional reduction methods seem to be ineffectual for the reverse oblique supracondylar humerus fractures.
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Objective To observe the effect of comprehensive nursing of traditional Chinese medicine and Western Medicine on children′s supracondylar humerus fracture of ulnar deviation on postoperative recovery. Methods From November 2015 to February 2016, 52 inpatients were divided into 2 groups by random digits table method after the external fixation removal surgery with 26 cases each. The observation group was intervened by integrated nursing and was given TCM rehabilitation guidance, while the control group was intervened by regular nursing and was given regular rehabilitation guidance. After 4 weeks, the therapeutic effect was evaluated according to Chinese Medicine Orthopedic Syndrome Diagnosis and their elbow joint function was evaluated by Flynn score. In 8 weeks of follow up, all the patients were valued by their quality of life. Results In the process of intervention, with 1 case fell off in the observation group, 3 cases fell off in the control group, so finally the observation group with 25 cases, the control group with 23 cases. Fifteen cases were cured, 7 cases were improved, 3 cases were not cured at 4 weeks after surgery in the observation group, 8, 6, 9 cases in the control group, and the difference was statistically significant (Z=-2.120, P=0.034). At 4 weeks after surgery, 10, 6, 6, 3 cases were excellent, good, medium and poor evaluated by Flynn score in the observation group, 5, 4, 5, 9 cases in the control group, and the difference was statistically significant (Z=-2.051, P=0.040). Incidence of postoperative complications was 8.0% (2/25) in the observation group, 30.4% (7/23) in the control group, and the difference was statistically significant (χ2=2.622, P=0.047). Physical, psychological, social and environmental fields of quality of life were 77.84 ± 12.15, 81.13 ± 15.72, 79.95 ± 20.68, 79.44 ± 11.57 in the observation group, 63.31 ± 15.86, 63.07 ± 12.63, 65.65 ± 18.51, 61.32 ± 17.24 in the control group, and the difference was statistically significant (t=2.516- 4.363, P<0.05). Conclusions Integrated nursing intervention with TCM rehabilitation guidance is a method which can effectively help in improving the elbow movement function and the life quality of children with supracondylar humerus fractures of ulnar deviation.
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Introduction: The supracondylar fracture of the distal humerus is the most common pediatric fracture around the elbow. The currently accepted techniques of fixation are two lateral parallel wires , crosswiring technique from the lateral side, two divergent wires laterally and two retrograde crossed wires. The retrograde crossed wires provide the best mechanical stability. Many children with this fracture have swelling around the elbow, making difficult the feeling of the anatomic landmarks for percutaneous pinning, increasing the risk of ulnar nerve injury. Objective: To evaluate the correspondence of the internal antecubital fold line with the internal epicondyle in patients with supracondylar fracture and the incidence of iatrogenic ulnar nerve injuries . Methods: We conducted a series of clinical cases. In the first group we included 56 children with supracondylar fracture Gartland type III, from August 2000 to September 2007, who underwent closed reduction and crossed retrograde nail fixation. In the second group we included 241 (481 elbows) outpatients with no anatomic abnormality. We used the extension of antecubital fold line to find the internal epicondyle in both groups. Results: The prolongation of the antecubital fold line intersected the medial epicondyle in all participants of the first group. In 96.3% of the participants in the second group, the extension of antecubital fold line intersected the internal epicondyle. None patient had iatrogenic ulnar nerve injury. Conclusions: The use of the antecubital internal fold line may be useful to identify the internal epicondyle and thus avoid iatrogenic ulnar nerve injury. Salud UIS 2012; 44 (2): 9-14.
La fractura supracondílea del húmero distal es la más común alrededor del codo en niños. Las técnicas actualmente aceptadas de fijación son dos clavos laterales paralelos, dos clavos cruzados laterales, dos clavos laterales divergentes y dos clavos retrógrados cruzados. Los clavos retrógrados cruzados, proporcionan la mejor estabilidad mecánica. La mayoría de los niños con fractura supracondílea presentan inflamación alrededor del codo, haciendo difícil la palpación de la epítroclea, aumentando el riesgo de lesión del nervio cubital. Objetivo: evaluar la correspondencia de la línea del pliegue antecubital interno con la epitróclea en pacientes con fractura supracondílea y la incidencia de las lesiones iatrogénicas del nervio cubital. Metodología: Realizamos una serie de casos clínicos. El primer grupo incluyó 56 niños con fractura supracondílea tipo III de Gartland, entre agosto de 2000 a septiembre de 2007, tratados con reducción cerrada y fijación con clavos cruzados retrógrados. El segundo grupo incluyó 241 (481 codos) pacientes de consulta externa. En ambos grupos utilizamos la línea antecubital interna para identificar la epitróclea. Resultados: La prolongación de la línea del pliegue antecubital intersecó la epitróclea en todos los participantes del primer grupo. No hubo lesión iatrogénica del nervio cubital. En el segundo grupo la línea del pliegue antecubital intersecó la epitróclea en el 96.3% de los pacientes. Ningún paciente presentó lesión del nervio cubital. Conclusiones: La extensión de la línea de pliegue antecubital interno puede ser útil para la identificación de la epitróclea y así evitar lesiones iatrogénicas del nervio cubital. Salud UIS 2012; 44 (2): 9-14.