Supracondylar fracture

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The Efficacy of Side Arm Traction in the Reduction of Supracondylar Fracture Humerus in Children

The Efficacy of Side Arm Traction in the Reduction of Supracondylar Fracture Humerus in Children

The Efficacy of Side Arm Traction in the Reduction of Supracondylar Fracture Humerus in Children ORIGINAL ARTICLE The Efficacy of Side Arm Traction in the Reduction of Supracondylar Fracture Humerus i[.]

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Original Article Postoperative comprehensive nursing care improved the prognosis and life quality of patients with minimally invasive retrograde intramedullary nail treatment for femur supracondylar fracture

Original Article Postoperative comprehensive nursing care improved the prognosis and life quality of patients with minimally invasive retrograde intramedullary nail treatment for femur supracondylar fracture

Supracondylar fracture of the femur severely affects the health and life quality of patients while trauma brings about acute stress re- sponses, altering the psychological and physi- ological status of patients [19, 20]. In light of the various complications following the supra- condylar fracture of the femur, patients, with- out any appropriate or in-time treatment, may be susceptible to deformity, which further exac- erbates the psychological health and life quali- ty of patients [21]. Clinically, surgery is the ma- jor treatment method for supracondylar frac- ture of the femur, but the large trauma in regu- lar surgery damages the suprapatellar bursa of the knee joint and results in a higher adhesion rate outside the joint, which gives rise to knee joint flexion dysfunction [22, 23]. However, in minimally invasive retrograde intramedullary nail surgery, needle delivery is guided using the
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Management of gartland type III supracondylar fracture of humerus in children by open reduction and internal fixation using crossed K-wires: A Short term follow up study

Management of gartland type III supracondylar fracture of humerus in children by open reduction and internal fixation using crossed K-wires: A Short term follow up study

It is the most common complication of supracondylar fracture of the humerus. Cubitus varus occurs after poor reduction or loss of reduction. Malunion of the fracture occurs in three planes: internal rotation in the horizontal plane, medial rotation in the coronal plane, and extension in the sagittal plane. It is more of a cosmetic deformity than functional. But patients having cubitus varus deformity find difficult in throwing sports, push-ups and swimming. In patients who do not tolerate the deformity corrective osteotomy should be considered,

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VOLKMANN'S CONTRACTURE AS A COMPLICATION OF SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN

VOLKMANN'S CONTRACTURE AS A COMPLICATION OF SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN

ned a supracondylar fracture of the left elbow after the fall on the left hand with elbow extended. She was admitted in local hospital where the clinical examination and X ray were made and they confirmed the diagnosis of supra- condylar fracture of the left elbow (Gartland Type III). She was treated with closed reduction (without anaesthe- sia) and cast immobilization for four weeks. With poor to no function of the left hand she was send to physical ther- apy for duration of 10 days, but she did not gain her func- tions of the left hand, almost all active movements of the left hand were impossible and the muscles of the left un- derarm were hypotonic. Due to loss of left hand function, EMG was made and the EMG result showed acute lesion of the nerves of left forearm caused by possible nerve compression (n. medianus, n. radialis and n. ulnaris). Af- ter four months she was admitted in University Clinic for Orthopaedic Surgery in Skopje were we perform opera- tion of the left elbow, with removing callus formation in which we find entrapped median and ulnar nerves. We al- so have done osteotomy of the humerus for correction of the angular deformity and fixation with K wire. The pati- ent was put in cast immobilisation after the surgery for fo- ur weeks. After the removal of the cast and K wire she was sent to intensive rehabilitation. One year after sur- gery she regains almost all of hand and elbow functions with satisfying range of motion. She is now able to fulfil every day function without any help or support.
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The use of tibial Less Invasive Stabilization System (LISS) plate [AO-ASIF] for the treatment of paediatric supracondylar fracture of femur: a case report

The use of tibial Less Invasive Stabilization System (LISS) plate [AO-ASIF] for the treatment of paediatric supracondylar fracture of femur: a case report

knee showed a displaced supracondylar fracture of the right distal femur with comminution both the medial and the lateral cortex. The fracture was classified as AO/ASIF (Arbeitsgemeinschaft Fur Osteosynthesefra- gen/Association for the Study of Internal Fixation) Type 33A [Figure 1a and 1b]. Closed reduction and fixation with tibia LISS plate was performed. (The rea- sons for choosing the LISS tibial plate were illustrated in the Discussion Section.) We performed lateral approach with incision over the right distal femur. After closed reduction of the fracture with satisfactory alignment, we inserted the tibial LISS plate in submus- cular plane and temporarily fixated it with Kirschner wires. We then inserted the locking screws through the jag. Intra-operatively, we took a bone biopsy to exclude the possibility of a pathological fracture and it showed no malignant cells. Post-operatively, he was on non-weight bearing walking for six weeks, partial- weight bearing walking for another six weeks and was given early knee mobilization exercises [Figure 2a and 2b]. On two months post-operatively period, there was no knee pain and the range of motion of the right knee was full [Figure 3a and 3b]. X-ray of the right knee showed that the fracture was united [Figure 4a and 4b]. He had implant removal one year after the operation [Figure 5a and 5b]. On post operative period two years, the right knee range of motion was full (0- 130 degrees) and there was no right knee pain.
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Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus: a before and after comparative study

Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus: a before and after comparative study

This before and after comparative study was approved by the institutional review board at our hospital (SNUBH IRB, B-1105/127-003). Consecutive children, who under- went closed reduction and internal fixation with percutan- eous pinning for supracondylar fracture of the humerus, since March 2009, were included in this study. The exclu- sion criteria were as follows: (1) patients who underwent open reduction and internal fixation; and (2) patients with open fracture or concomitant injury, which requires lon- ger hospital stay. Patients who underwent closed pinning between March 2009 and May 2011, before the implemen- tation of CP, were allocated to the pre-CP group, and patients who underwent closed pinning between June 2011 and May 2012, after the implementation of CP, were allocated to the post-CP group.
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Osteoid Osteoma of the Distal Humerus Mimicking Sequela of Pediatric Supracondylar Fracture: Arthroscopic Resection—Case Report and A Literature Review

Osteoid Osteoma of the Distal Humerus Mimicking Sequela of Pediatric Supracondylar Fracture: Arthroscopic Resection—Case Report and A Literature Review

with salicylates. A limitation of the flexion-extension arc was present (100 ∘ /−5 ∘ ) but both pronation and supination were preserved. The patient reported that even though she had not achieved full extension after the supracondylar fracture, the range of elbow motion had gotten worse over the past 2 years. In the radiological evaluation, bony consolidation with correct alignment was observed. A 20-degree Bauman’s angle

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A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

applying a valgus or varus force at the fracture site. The posterior displacement of the distal fragment was then corrected by applying a force to the posterior aspect while the elbow was gently hyperflexed and the elbow was secured in hyperflexion, and the reduction was confirmed by the image intensifier. The medial pin was placed directly through the apex of the medial epicondyle. The lateral pin was placed at the center of the lateral epi- condyle. For the lateral fixation technique, two or three pins were inserted from the lateral aspect of elbow across the lateral cortex to engage the medial cortex keeping the elbow in hyperflexion. Pins were placed either in parallel or divergent configuration with adequate separation at the fracture site. For the medial-lateral fixation technique, first the lateral pin was inserted from lateral cortex to engage the medial cortex keeping the elbow in hyperflexion. The elbow was then extended to\ 90° and the ulnar nerve rolled back with the opposite thumb and the medial pin was inserted to engage the lateral cortex with the elbow in\ 90° of flexion. The pin configuration was considered to be acceptable if one pin was placed in the lateral column and another in the central or medial column. If this was not achieved, we realigned the configuration by changing the pin placement. In the coronal plane, the pins were placed at an angle of 30° with the long axis of the humerus. After the pins were placed, the elbow was extended and the carrying angle was measured and compared with that on the non- affected side. The adequacy and stability of the reduction were checked under image intensification (Figs. 2, 3). The pins were bent to prevent migration and cut off outside the skin to allow removal in the outpatient clinic.
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Medial comminution as a risk factor for the stability after lateral-only pin fixation for pediatric supracondylar humerus fracture: an audit

Medial comminution as a risk factor for the stability after lateral-only pin fixation for pediatric supracondylar humerus fracture: an audit

Statistical analyses were performed using SAS software (version 9.1; SAS Institute, Cary, NC, USA). Measurement reliability for the Baumann angle, humerocapitellar angle, and pin separation at fracture site was expressed as intraclass correlation coef- ficient, which ranged from 0.763 to 0.869. Independent t-test was used to compare continuous data between supracondylar fracture with medial comminution (Group I) and supracondylar fracture without medial comminution (Group II). Chi-squared test was used to compare categorical data. There was very small difference between immediate postoperative angle and final follow-up angle in Baumann angle and humerocapitellar angle. We defined the significant angle change during fracture healing period as a change of more than average difference between immediate postoperative angle and final follow-up angle. Multivariable logistic regression analysis was done to find factors related to the significant change of Baumann
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Elbow your way into reporting paediatric elbow fractures – A simple approach

Elbow your way into reporting paediatric elbow fractures – A simple approach

The anterior humeral line is drawn along the anterior cortex of the humerus and should bisect the middle third of the capitellum. Since the line evaluates the relative positions of two parts of the same bone, malalignment indicates a fracture – in most cases, posterior displacement of the capitellum in a supracondylar fracture. This sign relies on adequate ossification of the capitellum and therefore is reliable in children over the age of 4 years only. 12 In younger children when the capitellar

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Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Fixation with K-Wire following supra- condylar fracture reduction toward children was firstly introduced by Casino (1960) it is an effective therapy in maintaining reduct- ion. Since then the fixation with K-Wire post supracondylar fracture reduction has become standard therapy for supracondylar humerus fracture among children. However research by Otsuka and Kasser (1997) finding there are complication related to K-Wire fixation including iatrogenic injury of ulnar nerve and reduction failure, that lead to cubitus varus deformity. Research by Gordon et al (2001) and Kalenderer et al. (2008) finding there are an optimal K-Wire configuration gives adequate fracture stability following the re- duction and minimizes the risk of reduction failure.
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Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

At 25 weeks after the initial surgery, she suddenly felt severe pain in her left thigh while she was walking and was unable to walk further. Radiological examinations revealed another fracture in the left femur (32-D/4.1 in AO-PCCF) at one of the half-pin insertion sites (Fig. 4). She underwent an external fixation again. After this operation, the patient sustained a refracture (32-D/4.1 in AO-PCCF) at the same fracture site, followed by a supracondylar fracture (33-M/3.1 in AO-PCCF) at a distant site of the femur (Fig. 5) and two consecutive frac- tures at the half-pin insertion sites (Fig. 6). The supracon- dylar fracture occurred without any triggering activity before beginning weight-bearing exercise. The supracondy- lar fracture was successfully treated conservatively, but she sustained two more consecutive diaphyseal fractures (32-D/4.1 and 32-D/4.1 in AO-PCCF) at the half-pin inser- tion sites (Fig. 6). She eventually underwent a revision sur- gery for the diaphyseal fractures with an Ender nail (Ender nail®, MIZUHO Co., Ltd., Tokyo, Japan). Open reduction was not easily achieved owing to the fracture deformity and growing callus. Only one nail could be passed through it because the medullary canal was significantly narrowed
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Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

Supracondylar fracture is a fracture of the distal humerus just above the epicondyles that runs transversely through the coronoid and olecranon fossae of the humerus [1]. It constitutes 16.6% of all pediatric fractures and 60% - 70% of all elbow fractures. These fractures are mostly encountered in children who are less than 8 years old. Generally, extension type fractures seen after falling on an outstretched hand (95% - 98%). The major factor that may contribute to the predisposition of these fractures is ligamentous laxity [2].

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THE TREATMENT OF PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES EVIDENCE-BASED GUIDELINE AND EVIDENCE REPORT

THE TREATMENT OF PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES EVIDENCE-BASED GUIDELINE AND EVIDENCE REPORT

Data on 48 outcomes from 11 studies formed the basis of this recommendation. For this analysis, Gartland Type II and III fractures were analyzed in aggregate since many of the studies combined the results from the two types. Similarly, the less common flexion type pediatric supracondylar fracture was included in this group. [Please refer to line 732 of this guideline for additional information.] The quality, applicability, and the strength of the evidence generated a preliminary strength of recommendation of “limited”. The work group upgraded the recommendation to “moderate” based on the potential for harm from non-operative treatment of displaced pediatric supracondylar fractures. For example, casting the arm in hyperflexion may cause limb threatening ischemia.
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Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Supracondylar fracture of humerus is the most common fracture in the children and needs proper management. This fracture is common in the first decade of life (1) due to various causes mainly ligament laxity and anatomical structure of humerus tube(shaft) to flat transformation at lower end of humerus. Its incidence decreases with age (2) . Its incidence is about 75% of fractures around elbow in children. Boys have a higher incidence than the girls. Common in left side or non dominant side.

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Delayed Open Reduction and K-Wire Fixation of Widely Displaced Supracondylar Fractures of Humerus in Children using Medial Approach

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Hence, a study was designed with the objective to assess the outcome of open reduction and internal fixation with crossed K-wires of widely displaced supracondylar fracture when operated later than 2 days after injury through the medial approach.

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Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

The Flynn criteria is widely used for the final assessment in the treatment of supracondylar fracture. According to the Flynn criteria, the final outcome of the treatment in this study showed 34 satisfactory (77.1% excellent, 14.3% good and 5.7% fair results) and only one unsatisfactory result. The unsatisfactory result was due to the poor post-operative range of motion compared to the normal elbow. No one developed cubitus varus deformity. Stephen Paul Guy, 9 and his colleagues

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CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

Supracondylar fracture of humerus has always been one of the most common and challenging fractures among the paediatric age groups. The main goal of the treatment is anatomical reduction and stable internal fixation. Thorough clinical examination is very crucial during the initial assessment of every patient. Closed reduction with K- wires fixation has been the gold standard in the management of these injuries. K-wires have the advantage of ease of use, decreased cost and reduced hospitalization stay [13,14] .

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Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

Patients were immobilized in an above elbow slab, and Gartland type II and III supracondylar fracture of the humerus were admitted to the hospital and scheduled for closed reduction and percutaneous pinning under general anaesthesia (Figs. 2–3). The arm was immobilized in 30–60 of flexion in an above elbow slab. The child was observed overnight and post-pinning antero-posterior and lateral view check X-rays of the affected elbow were taken and assessed regarding posterior, medial and lateral displacement as well as rotation of the distal fragment in sagittal, coronal and horizontal plane. Metaphyseal– diaphyseal angle were measured.
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A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

Patients: patients was diagnose as supracondylar fracture of the humerus surgery; intervention: closed reduction and percutaneous pinning as an intervention group; compari- son: open reduction and internal fixation as a comparison group; outcomes: cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection; study design: randomized controlled trials (RCTs) and non-RCTs. Two independent reviewers screened the title and abstracts of the identified studies after removing the duplicates from the search results. Any disagreements about the inclusion or exclusion of a study were solved by discussion or consultation with an expert. The reliability of the study selection was determined by Cohen’s kappa test, and the acceptable threshold value was set at 0.61 [6, 7].
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