Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury / 中国康复理论与实践

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.

Osteotomías correctoras en secuelas de fracturas supracondíleas de codo en la población pediátrica: revisión bibliográfica sistematizada

El cubito varo es la secuela más frecuente en las fracturas supracondíleas de humero en la población pediátrica, objetivo analizar los diferentes tipos de osteotomías y los métodos fijación para el tratamiento de estas lesiones. Materiales y métodos: se realizo una búsqueda bibliográfica utilizando como motor de búsqueda la plataforma Pubmed y OVID, las palabras claves fueron Cubitus AND varus AND osteotomy. Resultados: se seleccionaron 13 artículos, con un N de 237 pacientes, follow-up de 30 meses, edad al momento de la cirugía fue 8,78 años. La técnica de osteotomía más utilizada fue la de cierre lateral. 35.4% se fijaron con placas, 24.8% con fijadores externos y 33.3% fijación con kw/pins. Conclusión: las técnicas de osteotomías utilizadas actualmente logran corrección angular. No se encontraron diferencias significativas entre los resultados de las técnicas analizadas. No existe un implante que sea superior a otro a la hora de realizar la fijación de las osteotomías de humero distal. Cada implante tiene ventajas y desventajas.

Cubitus varus is the most frequent sequelae in supracondylar humeral fractures in the pediatric population, the objective is to analyze the different types of osteotomies and fixation methods for the treatment of these injuries. Materials and methods: a bibliographic search was carried out using the Pubmed and OVID platform as a search engine, the keywords were Cubitus AND varus AND osteotomy. Results: 13 articles were selected, 237 patients, follow-up of 30 months, age at the time of surgery was 8.78 years. The most used osteotomy technique was lateral closure. 35.4% were fixed with plates, 24.8% with external fixators and 33.3% fixation with kw/pins. Conclusion: the osteotomy techniques currently used achieve angular correction. No significant differences were found between the results of the analyzed techniques. There is no implant that is superior to another when fixing distal humerus osteotomies. Each implant has advantages and disadvantages.

A deformidade em varo do cotovelo é uma complicação comum das fraturas supracondilares do úmero na população pediátrica, o objetivo foi analisar os diferentes tipos de osteotomias e métodos de fixação para o tratamento dessas lesões. Materiais e métodos: foi realizada uma pesquisa bibliográfica utilizando as plataformas Pubmed e OVID como mecanismo de busca, as palavras-chave forom Cubitus AND varus AND osteotomy. Resultados: foram selecionados 13 artigos, com N de 237 pacientes, seguimento de 30 meses, idade no momento da cirurgia foi de 8,78 anos. A técnica de osteotomia mais utilizada foi a ressecção de cunha óssea com base laterala. 35,4% foram fixados com placas, 24,8% com fixações externas e 33,3% foram fixados com kw/pins. Conclusão: as técnicas de osteotomia utilizadas atualmente conseguem correção angular. Não forom encontradas diferenças significativas entre os resultados das técnicas analisadas. Não existe implante superior a outro na fixação de osteotomias distais do úmero. Cada implante tem vantagens e desvantagens.

Supracondylar Apophysis of the Humerus: Rare Cause of High Compression of the Median Nerve / Apófise supracondilar do úmero: Causa rara de compressão alta do nervo mediano

Abstract Supracondylar apophysis (SA) is a bony prominence that originates from the anteromedial aspect of the distal humerus with a lower projection and which, although usually asymptomatic, due to the relationship with adjacent structures can cause symptoms. We describe the case of a 42-year-old woman with pain complaints radiating from her elbow to her hand, with 6 months of evolution. On objective examination, the patient had a sensory deficit in the median nerve territory and decreased grip strength. Radiographs of the distal humerus were performed, in which a bone spike was visible, and magnetic resonance imaging showed thickening of the median nerve epineurium. Electromyography showed severe axonal demyelination of the median nerve proximal to the elbow. A median nerve compression caused by a SA was diagnosed. The patient underwent surgery and, 1 year after the operation, she had a complete clinical recovery. Supracondylar apophysis is a rare, but possible and treatable cause of high median nerve compression.

Resumo A apófise supracondilar (ASC) é uma proeminência óssea que tem origem na face anteromedial do úmero distal com projeção inferior e que, apesar de habitualmente assintomática, pela relação com as estruturas adjacentes pode causar sintomatologia. Descrevemos o caso de uma mulher de 42 anos, com queixas álgicas irradiadas do cotovelo à mão, com 6 meses de evolução. Ao exame objetivo, a paciente apresentava um déficit sensorial no território do nervo mediano e diminuição da força de preensão. Foram realizadas radiografias do úmero distal nas quais era visível uma espícula óssea, e na ressonância magnética era evidente o espessamento do epineuro do nervo mediano. A eletromiografia apresentou uma desmielinização axonal grave do nervo mediano proximal ao cotovelo. Foi diagnosticada uma compressão do nervo mediano por uma ASC. A paciente foi submetida à cirurgia e 1 ano pós-operatório apresentou recuperação clínica total. A ASC é uma causa rara, mas possível e tratável da compressão alta do nervo mediano.

STUDY OF SUPRACONDYLAR FEMUR FRACTURE MANAGED SURGICALLY USING LOCKING COMPRESSION PLATE.

Background- Fractures of distal femur are one of the most prevalent fractures encountered in high-velocity trauma which are associated with high morbidity and mortality if not managed well. The isolated fracture can itself lead to complications such as Acute Respiratory Distress and pulmonary embolism. This neccesitaties early stabilisation of the fractures. Open reduction and internal fixation (ORIF) with locking compression plate is the treatment of choice for closed fractures of the distal femur. Distal femur anatomic contoured locking compression plate (LCP) has shown to give one of the best results regarding recovery, fracture union, return to work and the functional outcome. We present our experience of management of distal femur fracture at our centre. Study Material and Methodsdone on 36 patients, (NEER'S Classification) age range of 18 to 70 years (irrespective of their sex), were subjected to fixation by locking compression plate after obtaining thorough written informed consent. The observational study was carried at our institute between June 2021 to June 2022 Patients of both gender who were skeletally mature are taken into the study. In 61.5% of patients up to 50 years old and in Results40% of patients older than 50 years, the functional evaluation of LCP using Neers criteria was excellent. There was no statistically significant (p>0.05) difference in patients' functional status according to their age group who had distal femur fractures, which were stabilise by LCP. For supracondylar femur fractures, locking compression plates is a safe technique that has a good functional outcome, early clinical and radiographic union, and few complications.

Risk factors for failure in closed reduction of flexed supracondylar humerus fractures in children / 中华创伤骨科杂志

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.

Treatment strategy for pediatric supracondylar humeral fractures with callus formation and displacement neglected for over 1 week / 中华创伤骨科杂志

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.

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children.@*METHODS@#Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria.@*RESULTS@#All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%.@*CONCLUSION@#The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children / 中国修复重建外科杂志

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.

Tratamiento de las fracturas supracondíleas de húmero en niños y fijación interna percutánea versus reducción sin fijación interna / Treatment of Supracondylar Fractures of the Humerus in Children and Percutaneous Internal Fixation versus Reduction with no Internal Fixation

Introducción: Las fracturas supracondíleas de húmero constituyen el segundo tipo de fracturas más frecuentes en niños. La prevalencia mundial oscila entre 3 y 16 por ciento, con predominio en varones. La urgencia de una atención inmediata radica en la prevención de complicaciones y secuelas. Objetivo: Describir los resultados del tratamiento de las fracturas supracondíleas de húmero en niños con fijación interna percutánea. edad, sexo, tipo de tratamiento empleado, complicaciones, y resultados finales obtenidos. Métodos: Se realizó un estudio descriptivo retrospectivo, en pacientes con fracturas supracondíleas de húmero en niños, atendidos en el Hospital Carlos Manuel de Céspedes de Bayamo, entre 2018 y 2019. Se calcularon frecuencias absolutas y porcentajes. Se evaluaron las siguientes variables: edad, sexo, tipo de tratamiento empleado, complicaciones, y resultados finales obtenidos. Resultados: Las fracturas supracondíleas de húmero fueron más frecuentes en el sexo masculino (69,6 por ciento) y en el grupo de edad comprendido entre 6 y 10 años para ambos sexos. El 60,8 por ciento de estas fracturas se trataron con reducción y fijación interna con agujas de Kirchner. En el grupo con fijación interna predominaron las de tipo IV y en el grupo que no requirió fijación interna predominó el tipo I. En general, en los pacientes con fijación interna predominaron los resultados excelentes y buenos. Conclusiones: Se obtuvieron mejores resultados en los casos donde se realizó la reducción combinada con fijación interna(AU)

Introduction: Supracondylar fractures of the humerus are the second most frequent type of fractures in children. The worldwide prevalence ranges between 3 and 16 percent, with predominance in males. The urgency of immediate care lies in the prevention of complications and sequelae. Objective: To describe the results of the treatment of supracondylar fractures of the humerus in children with percutaneous internal fixation. Methods: A retrospective descriptive study was carried out in patients with supracondylar fractures of the humerus in children, treated at Carlos Manuel de Céspedes Hospital in Bayamo, from 2018 to 2019. Absolute frequencies and percentages were calculated. The variables evaluated were age, sex, type of treatment used, complications, and final results obtained. Results: Supracondylar fractures of the humerus were more frequent in males (69.6 percent) and in the age group between 6 and 10 years for both sexes. 60.8 percent of these fractures were treated with reduction and internal fixation with Kirchner wires. In the group with internal fixation, type IV predominated, also type I predominated in the group that did not require internal fixation. In general, excellent and good results predominated in patients with internal fixation. Conclusions: Better results were obtained in patients who underwent reduction combined with internal fixation(AU)

Tratamiento de las fracturas supracondíleas de húmero en niños con fijación interna percutánea versus reducción sin fijación interna / Treatment of supracondylar fractures of humerus in children with percutaneous internal fixation versus reduction without internal fixation

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.

Clinical observation of supracondylar fracture of humerus requiring surgical nerve exploration / 中国综合临床

Objective:To investigate the clinical effect of minimally invasive treatment of supracondylar fracture of humerus with nerve injury and the need for surgical exploration of nerve.Methods:From August 2017 to September 2020, 34 cases of children with supracondylar fracture of humerus with nerve injury in the Department of orthopedics of Shanxi Children′s Hospital were selected for retrospective analysis.Closed reduction, Kirschner wire fixation and small incision surgery were used to explore the injured nerve.The follow-up period ranged from 6 months to 3 years, with a follow-up time of (2.15±0.49) years.The elbow function, radial nerve, median nerve and ulnar nerve function were evaluated according to the trial standard of upper limb peripheral nerve function evaluation of Hand Surgery Society of Chinese Medical Association.Results:The elbow function of children in this group: excellent 31 cases, good 2 cases, fair 1 cases, poor 0 cases, excellent 33 cases.Three patients failed to take early functional rehabilitation exercise.Two patients recovered after 2.5 months of treatment by professional orthopedic rehabilitation therapists and physical therapy.One of them did not cooperate with functional rehabilitation training.After 3.5 months of treatment by orthopedic rehabilitation therapists, elbow and finger functions were not affected.Two weeks after nerve injury: radial nerve function evaluation: excellent in 15 cases, good in 3 cases, fair in 4 cases, poor in 0 cases, excellent in 18 cases.Median nerve function evaluation: excellent in 5 cases, good in 2 cases, fair in 6 cases, poor in 0 cases, excellent in 7 cases.Ulnar nerve function evaluation: excellent 5 cases, good 0 cases, fair 1 cases, poor 0 cases, excellent 5 cases.At 3 months after injury, the excellent and good rate of radial nerve, median nerve and ulnar nerve was 100%.Conclusion:The supracondylar fracture of humerus with nerve injury is treated by minimally invasive surgery, and the nerve exploration is still a few.The recovery of nerve injury after surgery is smooth, and the clinical effect is good.

Effect of the fracture line direction in the sagittal profile on the Gartland type Ⅲ supracondylar humerus fractures in children / 中华实用儿科临床杂志

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.

Distal Humeral Shaft Fracture with Simultaneous Ipsilateral Supracondylar Humeral Fracture in a Child: A Case Report

@#In children, simultaneous ipsilateral fracture of the distal shaft humerus and supracondylar humerus is rare. To the best of our knowledge, there are no available data on supracondylar humeral fracture (SCHF) combined with ipsilateral distal humeral shaft fracture. This report aimed to discuss a novel case with an appropriate management scheme. We present a case of a 5-year-old boy with ipsilateral distal shaft humerus fracture and SCHF. He underwent closed reduction and antegrade elastic stable intramedullary nail (ESIN) fixation with good clinical outcome. These injuries affect a child’s bony growth, and careful treatment is warranted. Upper extremity fractures could present in different combinations. The ESIN procedure with antegrade technique facilitated reduction and fixation of the fracture by prevention of iatrogenic ulnar nerve injury or pin-tract infection. Moreover, it allowed performance of early range of motion exercises.

Comparative Study Regarding Functional and Radiological Outcomes of Different Modes of Fixation for Distal Femur Fracture.

Treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections. The objective was to compare the functional and radiological outcome of fracture distal femur treated by open reduction with LCP by minimally invasive plate osteosynthesis (MIPO). We wanted to compare the clinical and radiological differences between open and MIPO techniques for distal femoral fracture fixation.METHODSThis was a prospective interventional study. 41 subjects with closed supracondylar femur fracture treated surgically from March 2013 to December 2017, were evaluated prospectively for functional and radiological outcome results after fixation with distal femoral locking compression plate in open or minimally invasive way, with minimum follow up of 1 year. IBM SPSS Ver. 25 software was used to perform statistical analysis.RESULTSThe mean age of 41 treated patients was 53.8 ± 13.7 years and ranged from 23 to 84 years. 19 patients were females and 22 were males. Mean time to surgery was 5.7 ± 2.9 days with minimum 2 and maximum of 18 days from injury. Initially 20 patients underwent open surgery and 21 patients were operated by minimally invasive plating technique. In all cases, a 316L stainless steel alloy distal femoral locking plate was used.CONCLUSIONSKnee ROM could be started at a mean of 1.4 weeks earlier in the MIPO group and this was statistically significant. The two groups did not differ significantly in start of full weight bearing. Knee flexion at 6 weeks was also comparable in the two groups. However, knee flexion was average 21.9° higher in MIPO group at 1 year which was significantly different than ORIF group. The proportion of patients with >90° and >110° knee flexion also varied significantly between the groups. VAS score in MIPO group was significantly less at 6 weeks but difference was non-significant at 1 year. There were 2 cases with non-union and implant failure in the ORIF group, but the proportion was not significant. There was 10° FFD in 1 patient of ORIF group, while varus deformity occurred in 3 patients of MIPO group. The proportion of deformity was not significantly different between the two groups.

Fractura supracondílea de húmero y extremidad sin pulso. Uso de oximetría de pulso como predictor de lesión vascular en un caso pediátrico / Pulseless limb and supracondylar humeral fracture; use of pulse oximetry as a predictor of vascular injury in a pediatric case

Las fracturas supracondíleas del húmero (FSCH) representan la segunda lesión más frecuente en la infancia. La clasificación de Gartland, de acuerdo con la dirección y magnitud del desplazamiento orienta hacia su tratamiento. Las fracturas grado I solo requieren inmovilización y los grados del II al IV necesitan reducción generalmente cerrada, y fijación con agujas de Kirschner percutáneas. En los grados III y IV las lesiones neuro-vasculares se pueden presentar debido a las relaciones anatómicas de la fractura. La lesión vascular se debe sospechar y tener siempre en cuenta, debido a las secuelas que se pueden presentar de no tomar una conducta adecuada a tiempo. Actualmente existe controversia acerca de cuándo realizar la exploración quirúrgica ante una extremidad bien perfundida, sin pulso radial como resultado de una FSCH. Varios autores han reportado la utilidad de la onda de pulso en la oximetría como predictor de lesión vascular. En este artículo se presenta un caso clínico de FSCH con extremidad sin pulso y lesión de la arteria braquial, su manejo y evolución final.

Supracondylar fractures of the humerus are the second most frequent lesion of infancy. Gartland's classification uses the direction and magnitude of the displacement to determine its treatment. Grade I fractures need only immobilization and grades II to IV need reduction, generally closed, and percutaneous fixation with Kirschner needles. Neurovascular lesions may be present in grades III and IV because of the anatomic relations to the fracture. Vascular injury must always be suspected and taken into consideration because of the sequelae that may occur if not given adequate treatment promptly.There is currently controversy over when to do a surgical exploration in a well-perfused limb with absent radial pulse resulting from a supracondylar humeral fracture. Several authors have reported the usefulness of the waveformof the pulse oximeter in predicting vascular injury. In this article we present a clinical case of supracondylar humeral fracturewithpulseless limb and brachial artery injury, its management, and the outcome.

Manejo de fractura de cuello femoral en paciente con amputación supracondílea femoral bilateral y revisión de la literatura / Femoral neck fracture management in patient with bilateral femoral supracondylar amputation and literature review

Resumen: El tratamiento de un paciente con amputación supracondílea femoral bilateral, y que ha sufrido una fractura de cuello femoral, es un evento poco común tanto para el cirujano ortopédico como para el equipo de rehabilitación. Presentamos un caso, en el cual se discuten diferentes dificultades en su tratamiento, elección de implante y regreso a sus actividades diarias. Se trata de un joven con diagnóstico de amputación traumática bilateral supracondílea, con fractura de cuello femoral, tratado mediante artroplastía total de cadera primaria no cementada. La evaluación de la funcionalidad de la prótesis total de cadera con escala de Houghton fue al cabo de 12 meses, se obtuvo una puntuación final de 9 puntos, los cuales son el resultado de una rehabilitación satisfactoria.

Abstract: The treatment of a patient with amputation above the knee who has suffered a femoral neck fracture is a challenge for both the orthopedic surgeon and the rehabilitation team. We present a case, in which different difficulties are discussed in their treatment, choice of implant and return to their daily activities. The clinical case of a young man diagnosed with supracondylar bilateral traumatic amputation, with fracture of the femoral neck, treated by total non-cemented hip arthroplasty is presented. The functionality of the total hip prosthesis with Houghton scale after 12 months, obtaining a final score of 9 points which are the result of a satisfactory rehabilitation.

Distal humeral fracture: an epidemiological analysis of orthopedic patients for children / Fratura de úmero distal: uma análise epidemiológica de pacientes ortopédicos infantis

ABSTRACT Objective: To analyze the epidemiological profiles of children with orthopedic distal humerus fractures. Methods: An analytical descriptive study was conducted with a retrospective approach using medical records of 665 orthopedic children who attended the Jesser Amarante Faria Children's Hospital, a reference hospital in the city of Joinville, Santa Catarina, between June 2012 and December 2016. Results: The results showed a predominance of male patients (64.2%), with a mean age of 7 years, and the age group of 6-10 years being the most frequent with 319 patients (48%). The main mechanism of trauma was fall of height in 59.7% of patients, Gartland type 1 fracture in 57.1%, and absence of vascular injury in 99.7%. Conservative management was implemented in 64.7% (95%) of patients. Absence of neurological lesion (95.6%) and closed lesion (99.4%) were the main epidemiological characteristics of patients in the study. A low complication rate was observed, with reduction losses in 1.7% of patients, followed by infections in 1.1%. Conclusion: We can conclude that the cases studied presented epidemiological characteristics similar to those described in the literature. Level of evidence IV, Description of a case series, with analysis of results, without a comparative study.

RESUMO Objetivo: Analisar o perfil epidemiológico de pacientes ortopédicos infantis com fratura de úmero distal. Método: Estudo analítico-descritivo, com abordagem retrospectiva dos prontuários médicos de 665 pacientes ortopédicos infantis, atendidos no Hospital Infantil Dr. Jeser Amarante Faria, referência no município de Joinville (SC), do período de junho de 2012 a dezembro de 2016. Resultados: Os resultados mostraram um predomínio de pacientes do sexo masculino (64,2%), com idade média de 7 anos, sendo a faixa etária de 6 a 10 anos a mais frequente, com 319 (48%) pacientes. O principal mecanismo do trauma foi por queda da própria altura (59,7%), com Gartland 1 em 57,1% dos casos e ausência de lesão vascular (99,7%). A conduta conservadora foi observada em 64,7% dos pacientes, além de ausência de complicações imediatas (97,1%), complicações tardias (95,3%) e lesão neurológica (95,6%). Lesão fechada (99,4%) foi a principal característica epidemiológica dos pacientes estudados. Uma baixa frequência de complicações foi observada, sendo mais prevalentes as perdas de reduções (1,7%), seguidas de infecções, em 1,1% dos casos. Conclusões: Os casos estudados apresentaram características epidemiológicas semelhantes àquelas descritas na literatura. Nível de evidência IV, Descrição de série de casos, com análise de resultados, sem estudo comparativo.

Various Modalities for Fixation of Fracture Supracondylar Humerus in Pediatric Age Group

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.

Evaluation of Functional Results in the Management of Supracondylar Fracture of Humerus in Children by Various Methods

Introduction: Supracondylar fractures of Humerus are one of the most common fractures in pediatric age group. The aim ofthe study was to evaluate the functional results in the management of supracondylar fracture of humerus in children by variousmethods.Materials and Methods: This study was conducted at the Orthopaedics department of Mahatma Gandhi MemorialHospital, Warangal. This was a 2 years prospective, longitudinal, hospital based, observational study and its outcomes.Participants were a total of 30 children aged 0 to 14 years (21 males, 9 females) diagnosed with supracondylar fractureof humerus.Results: Patients were assessed by Flynn’s criteria. Results were excellent in 70%, good in 20%, fair in 6.66%, and poor in 3.33%.Conclusion: Closed reduction and external immobilization are reserved for Gartland’s type 1 and select type 2 fractures. Inunstable type 2 and type 3, closed or open reduction and K-wire fixation give better results.

Functional Outcome Analysis of Fracture distal end femur treated with distal femur LCP - A Prospective Study

Supra-condylar and inter-condylar fractures of the distal femur historically have been difficult to treat. They account for 7% of all femoral fractures. If hip fractures are excluded, 31% of femoral fractures involve distal portion. Because of the proximity of these fractures to the knee joint, regaining full knee motion and function may be difficult. Many of these fractures are the result of high energy trauma which generates severe soft tissue damage and articular and metaphyseal comminution, the management of which still remains complex and challenging to the orthopedic surgeons. The incidences of mal-union, non-union and infection are relatively high. Methods: A total of 25 patients were enrolled for this prospective study and all were treated with locking compression plate. Physical examination and radiographs were performed at regular follow-ups. Functional outcomes were analyzed using Modified Hospital for Special Surgery scoring system. Results: Patients were followed up every 2 weeks in the first month, then monthly for 3 months and then once every 3 months. The average range of knee flexion achieved was about 101°. The average knee score was 88.88 rated using Modified Hospital for Special Surgery functional score.The difference in knee range of motion was statistically significant for closed and open fractures but knee score and age was not statistically significant. Intra-articular fractures tend to have poorer results with respect to pain and function, more so because of the nature of the injury rather than the implant used, which limits the movement and causes loss of strength more than instability. Conclusion: The outcome seems to correlate with fracture severity, anatomic reduction, etiology, bone quality, length of time elapsed from injury to surgery, concomitant injuries and the exact positioning and fixation of the implant. Furthermore, the initial severe concomitant cartilage damage may predispose to early osteoarthritis although there is no evidence of that. Closed fractures have a higher range of motion as well as a better knee score as compared to open fractures thereby showing that soft tissue compromise also affects range of motion and further rehabilitation of the limb.