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Resumen: Introducción: Las fracturas supracondíleas de húmero constituyen el segundo tipo de fracturas más frecuente en niños. Objetivo: Describir los resultados del tratamiento, los pacientes según edad, sexo, complicaciones y resultados finales. Material y métodos: Se realizó un estudio descriptivo retrospectivo, en pacientes con fracturas supracondíleas de húmero durante los años 2018-2019. Se calcularon frecuencias absolutas y porcentajes. Resultados: Las fracturas fueron más frecuentes en el sexo masculino (69.6%) y en el grupo de edad de seis a 10 años para ambos sexos. 60.8% de las fracturas se trataron con reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predominan las tipo IV y en el grupo que no necesitó fijación interna predominó el tipo I, la complicación más frecuente fue la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna (91.2%). Conclusiones: Las fracturas predominaron en el sexo masculino y en el grupo de edad de seis a 10 años, fue más frecuente la reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predomina las tipo IV, predominó la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna.
Abstract: Introduction: Supracondylar fractures of humerus are the second most frequent type of fractures in children. Objective: To describe the results of the treatment, the patients according to age, sex, complications, and final results. Material and methods: A retrospective descriptive study was conducted in patients with supracondylar fractures of humerus during the years 2018-2019. Absolute frequencies and percentages were calculated. Results: Fractures were more frequent in males (69.6%) and in the age group of six to 10 years for both sexes. 60.8% of the fractures were treated with reduction plus internal fixation with Kirschner needles, in the group with internal fixation type IV predominates and in the group that does not need internal fixation predominate type I, the most frequent complication was the loss of reduction in the group that was not fixed with needles. Better results were obtained when the reduction was performed combined with internal fixation (91.2%). Conclusions: Fractures predominated in the male sex and in the age group of six to 10 years, the reduction was more frequent more internal fixation with Kirschner needles, in the group with internal fixation predominates type IV, predominated the loss of reduction in the group that was not fixed with needles. Better results were obtained when reduction was performed combined with internal fixation.
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Background: The objective of the present study is to analyze & compare various modalities available for management of fracture supracondylar humerus in pediatric population. Methods: The present prospective study was conducted in the department of Orthopaedics and Traumatology Ananta institute of medical sciences and research centre, Rajsamand from December 2015 to April 2018. Results: In our study we found that in Grade II and III supracondylar fracture of humerus in children closed reduction is difficult to achieve and is complicated by slippage of reduction leading to fixation with k-wires in early presentation or malunion deformity in cases of late presentation and vascular comprise if excessive flexion is done to hold reduction. While Grade I fracture can effectively be managed with closed reduction & cast with caution of maintaining reduction. Conclusions: In this study we found that results of displaced supracondylar fracture of humerus presenting can be effectively best treated by closed reduction with percutaneous pinning because patients who were treated conservatively developed deformities more than closed reduction and internal fixation group. Patients with cross k-wire fixation from either condyle has better outcome as compared to lateral entry cross k-wire fixation.
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Background: In the past two decades, the open reduction andinternal fixation has gained good result in the management ofdistal femur fractures. The present study has been undertakento evaluate the overall functional outcome of patients treatedby supracondylar nail.Materials and Methods: The present study was conducted atDepartment of Orthopaedics, Teerthanker Mahaveer MedicalCollege and Research Centre, Moradabad, UP, India. All thepatients admitted in the department of Orthopaedics withfracture distal femur and managed by intramedullarysupracondylar nail were included. Final assessment of resultswas done based on modified Mehrotra's grading based on theassessment of the final functional results and also taking intoconsideration, the complications if any.Results: Average duration between injury and surgery was3.38 days. In only 8% of the cases open reduction by additionalparapatellar incision was required. Average duration of surgerywas 52.6 minutes. Most common complication we encounteredwas knee stiffness in 16 cases followed by local symptom atdistal screw site in 12 cases. Superficial infection was seen in 9& deep infection in 2 cases. In 2 cases shortening was morethan 2.5 cm. Average range of movement at the knee joint inour series was 110.93 with 40 cases having full range ofmovement. Final results were excellent in 61 of the cases.Good in 23% Fair in 11%, Poor in 5%.Conclusion: Finally we conclude that intramedullarysupracondylar nail should be the treatment of choice for distalfemoral fractures. As it has all the advantages of closedtreatment like minimal blood loss, less soft tissue stripping,preservation of fracture haematoma and minimalcomplications. This operation is particularly suited for Type A,C1 & C2 types of fractures as shown by the final functionalresults of this study.
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<p><b>PURPOSE</b>This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries.</p><p><b>METHODS</b>All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years.</p><p><b>RESULTS</b>We analysed a total of 263 patients and most of the fractures were seen in 5-8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 (23.95%) and type 2 (21.67%).</p><p><b>CONCLUSION</b>Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.</p>
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The aim of the present study was to analyze the results of fixation of supracondylar fractures by open vs. closed reduction followed by internal fixation with k wires and assessing the union radiologically, complications associated with the procedure and restoration of range of motion and function of the elbow and to evaluate the results clinically regarding pain, stiffness, range of motion. A total of 40 cases were admitted for fracture supracondylar type 3. Out of them open reduction was done in 20 and in other 20 closed reduction was done. All 40 were fixed by internal fixation with k wires. The age of the patients in this study ranged from 4 yrs to 11 yrs. Males formed 75 %of the patients. 97.5 % fractures were extension types and the rest were flexion types. Left side was involved commonly (60 %). Duration from injury to surgery was an average of 23 hours. Mean procedure duration for closed group was 20 minutes and in open group was 70 minutes. Hospital stay in pt.s treated by closed reduction was 24 hrs (1 day). In patient treated by open reduction mean hospital stay was 5 days. Overall excellent results were found in 60 % in closed group and 35% in open group.
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Objective To evaluate the clinical effect of dual-plate for treatment of comminuted distal humerus fractures in adult. Meth-ods 28 patients with distal humeral fractures were treated with condylar anatomical plate interal fixation. The supracondylar fracture was fixed with condylar anatomical plating, and the two plates were kept in 90°with each other. Results The 28 cases were followed up average-ly 26 months (12 to 34 months). All fractures healed and there was no delayed union or nonunion cases. According to Cassebaum scoring system, there were 9 cases of excellent,14 cases of good, 4 cases of moderate and 1 case of bad. According to Morrey-Chao scoring system, there were 16 cases of cases,11 cases of good. The average time of bone healing was 10 weeks. Conclusion In treatment of comminuted distal humerus fractures in adult, open reduction and dual-plate internal fixation can get good clinical results. The placement of the dual-plate may depend on surgeon experience and preference and the fracture pattern present.
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Objective Effect of psychological intervention on functional rehabilitation of femoral supracondylar fractures.Methods 84 type C fracture patients according to AO criteria for the diagnosis were collected,and randomly divided into intervention group(n=42)and control group(n=42)according to patient sex,age,fracture condition,cultural degree balanced matching principle.The control group was given conventional treatment and fracture features of health guidance,the intervention group in addition to conventional treatment and rehabilitation guidance.Comprehensive mental intervention applied 4 times on postoperative 3 days,the 2nd,3rd,4th week.Self-anxiety scale and self-depression scale were used before operation and 6th month after operation.Results The anxiety and depression scores in two groups before intervention showed no significant difference P>0.05).6 months after the operation,the anxiety score(41.6±9.4 vs 48.7±8.5)and depression score(40.6±7.6 vs 47.4±9.2)in intervention group apparently decreased than that in control group(P<0.01).Function restoration of knee joint in different effect showed better than control group(u=-2.0591,P<0.05).Conclusion Psychological intervention can effectively promote the functional recovery of patients with femoral supracondylar fractures and promote anxiety and depression mood.
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PURPOSE: To evaluate the radiological and clinical outcomes after operative treatment of displaced supracondylar fractures in children with lateral K-wire fixation. MATERIALS AND METHODS: 69 displaced supracondylar fractures treated by closed reduction and percutaneous lateral K-wire fixation were included in this study. Carrying angle and range of motion were measured and graded by the Flynn criteria. To assess the accuracy of the reduction, Baumann angle and lateral humerocapital angles were compared to the contralateral side, and to evaluate the stability of fixation both measurements were taken immediately postoperatively and after K-wire removal. RESULTS: 55 cases (80%) were categorized as excellent and 12 cases (17%) as good. There were no significant statistical differences in Baumann angle and lateral humerocapital angle between postoperative and K-wire removal. Although there were 9 cases that showed differences in Baumann angle and 32 cases in lateral humerocapital angle of more than 10 degrees compared to the opposite side at the immediate postoperative radiograph, 9 cases showed satisfactory clinical results. CONCLUSION: Closed reduction and lateral K-wire fixation is considered as an acceptable modality of the treatment of displaced supracondylar fractures in children, and clinical outcome is more closely correlated with carrying angle and stability of fracture site rather than rotational deformity or hyperextension of fragment measured radiographically.
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Niño , Humanos , Anomalías Congénitas , Húmero , Rango del Movimiento ArticularRESUMEN
Objective To discuss the indication and complication of overhead traction of olecranon for displaced extension-type GartlandⅢ supracondylar fracture of the humerus in children.Methods Total of 87 patients(Gartland Ⅲ) proceeded with overhead skeletal traction of ulnar olecranon,including 68 cases of ulnar deviation and 19 cases of radial deviation.Eighteen cases had complicating revolve deviation.According portable X-ray results in the 2nd and 5th,three-dimension adjustment was performed within 1 week.Five patients were treated by open reduction because of symptoms nerves and blood vessel compression.When X-ray examination showed good callus formation and stable reduction,the patient was discharged after the elbow was stabilized in flexion position with plaster fixation,which was removed in 2 weeks.Results Sixty-seven of 87 patients were followed-up for 18 months.All of them had excellent results except one who had permanent ulnar nerve injury.No cubitus varus was observed.Conclusions The overhead olecranon skeletal traction is a simple,effective method,because it can increase joint motion,relieve elbow swell and pain rapidly,and improve upper limb line of traction.However,open reduction shall be done promptly if there is evidence of nerve,blood vessel or soft tissue between broken ends of fractured bone within 5 days.
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135 children aged 7-15, with fracture in the brachial condylus treated by continous stretching using Kirchner needle on Ponliquen frame and Crame lath during 2 weeks, then fixed by 2 bamboo laths. The procedure showed a 100% conservative recovery. Very good result reached in 86.8%, good 7.5% and bad 5.7%. No case needed surgical intervention
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Niño , Húmero , Fracturas del HúmeroRESUMEN
Supracondylar fracture of the humerus is the one of the commonest elbow fracture in children. There are much controversies surrounding the method of treatment for various and frequent complications such as cubitus varus and joint stiffness, etc. For the period of 2 years and 8 months from Jan. 1987 to Aug. 1989, 32 patients had undergone treatment at the Department of Orthopaedic Surgery, Choongang Gil Hospital. Ten cases among them were treated with close reduction and cast, 8 cases were treated with close reduction and pinning, and 14 cases were treated with open reduction and internal fixation. The results obtained are as follows; l. Of all fractures, extension type was 96.9%, and flexion type was 3.1%. According to the Holmberg classification, 5 cases belong to Group I (15.6%), 10 to Group II (31.3%), 7 to Group III (21.9%), and 10 to Group IV (31.3%). 2. Radial nerve injuries which now are thought to be neuropraxia were the most common form of concomitant injuries. 3. All fractures were found to obtain bone union with mean duration of bone union about 40.9 days. 4. There were 7 cases (21.9%) who had more than 10 degrees of elbow motion limitation. Three cases (9.4%) showed the change of carrying angle over 10 degrees in Group IV by Holmberg classification. 5. By the modified Mitchell and Adams' criteria for grading results, Excellent was 22 cases (68.7%), Good was 7 cases (21.9%), Fair was 2 cases (6.3%), and Poor was 1 case (3.1%). 6. In Holmberg classification, the higher severity, the longer mean duration of bone union and the higher joint stiffness made the prognosis worse.
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Niño , Humanos , Quistes Óseos , Clasificación , Codo , Húmero , Articulaciones , Métodos , Pronóstico , Nervio RadialRESUMEN
Supracondylar Fractures of the femur are not as cammon as femoral neck or intertrochanteric fractures, but their treatment may be just as difficult. Few surgeons have had extensive experience with this complex fractures of uncommon frequency. Until a few years ago, conservative treatment was considered superior to internal fixation of supracondylar fractures of the femur in adults. However, the development of new fixation devices and techniques has, according to several investigations, improved the results of the treatment of these fractures. The following clinical results were shown by analysis of 27 cases of femoral supracondylar fractures experienced in the Department of Orthopedic Surgery, Capital Armed Forces General Hospital in the past 3 years from Jan. 1977 to Oec. 1979. 1. The most common cause of these fractures were traffic accidents. 2. Of 27 cases, 11 cases were treated by conservative method, 16 cases were treated by open reduction and internal fixation. 3. Anatomical reduction and rigid internal fixation led to 80% of good to excellent results whereas only 33.4% of good to excellent results were obtained in patients in whom the fixation was not absolutely rigid. 4. In the treatment of supracondylar fractures of the femur, anatomical reduction and rigid internal fixation (80% of good to excellent results) resulted in better functional recovery after union of fractures than conservative treatment (45.5%).