Top PDF 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

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

series of 375 patients by Lyons JP et al., they observed that 6% of the patients had an iatrogenic ulnar nerve palsy postoperatively [18]. They also stated that these are usually neuropraxia which resolves almost completely in majority of the situations. There were 25 cases in Group B in the present study, who had ulnar nerve neuropraxia postoperatively and who recovered completely within three weeks of surgery. The incidence of neuropraxia can be reduced by keeping the elbow in 45-50 degrees of flexion rather than the usual hyperflexed position used while inserting the lateral pin. No pin removal was required in the present study for the neuropraxia. In all the patients where cross pinning was executed, a mini- open approach was used, the ulnar nerve was palpated and the K-wire was introduced with the elbow in semi- extended position.
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A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

Though seven studies [11,14,18,23-26] have been done so far to compare the efficacy of medial and lateral entry pinning with lateral entry pinning for percutaneous fixa- tion of displaced (Gartland [4] type II and type III) exten- sion type supracondylar fractures of the humerus in children but, it is very difficult to compare between them because: (i) pinning technique, pin size, position of elbow during pinning differs in various studies, (ii) only one study [11] consists of more than 50 patients in each group but, that was a retrospective study, (iii) Most of the studies are retrospective and uncontrolled [11,14,18,24,25]. Only two studies [23,26] are randomized controlled but, these studies consist of less than 50 patients in each group. All of these studies found no significant difference between
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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

Open reduction is indicated in displaced supracondylar fractures where irreducibility results from proximal fragment being buttonholed 16 through soft tissue or interposition of biceps or neurovascular structures. Approaches for open reduction are anterior, posterior, medial and lateral. Posterior approach through triceps muscle and tendon has been used with excellent results. Posterior approach 23,24,25 is easier when comparing with other approaches. K wires 1.5mm to 2mm are used in crossed pin technique. After reducing the fracture visually lateral pin is inserted first and second pin is placed medially. Both the pins should have a purchase on the opposite cortex. Elbow is immobilised in flexion with forearm in neutral position using above elbow posterior slab.
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Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Although closed reduction and percutaneous pinning stabilization is the current gold standard in managing displaced supracondylar fractures of the humerus in children, there is still controversy on the pin configuration of K-wires based on fracture stability biomechanics and ulnar nerve safety. In this series, a modified cross wiring technique, performed from the lateral side only ,was studied. In the present study, using Flynn’s score [9] , 80 % of the patients achieved a satisfactory outcome and 4 patients (20%) achieved unsatisfactory result (loss of range of movement).
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Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Supracondylar fracture of the distal humerus is a common fracture in the pediatric population, accounting for approxi- mately 60% of all fractures of the elbow [1]. Since1948, Swenson firstly described two K-wires of different sizes for closed reduction of supracondylar humerus fractures [2]. The classical treatment of displaced supracondylar humeral fractures is closed reduction and percutaneous fixation of Kirschner wires (K-wires). Previous studies have shown that medial and lateral crossed-pin fixation provided more sta- bility in biomechanical analysis than two lateral pin fixation [3]. However, crossed K-wire placement is associated with the risk of iatrogenic ulnar nerve injury up to 3 to 4%. Lee et al. [4] reported that three lateral divergent or parallel pin fixations were effective and safe in avoiding iatrogenic ulnar nerve injury in supracondylar humeral fractures. In Bogdan et al.’ s [5] study, the humero-ulnar external fixation is a good alternative to lateral or crossed pinning in supracon- dylar humeral fractures. The optional K-wire configuration could provide the adequate stability of fracture without the risk of neurovascular injury.
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Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

previous studies reported that ulnar nerve in- jury caused by medial K-wires ranges from 1.4% to 15.6% [22]. In our study, medial K-wi- re was inserted through the epicondylus me- dialis humeri to avoid ulnar nerve palsy. How- ever, ulnar nerve palsy developed in three (12%) patients. After K-wire was extracted, nerve palsy was gradually recovered. In previ- ous studies, the medial K-wires could increa- se the risk of ulnar nerve injury compared with lateral K-wires fixation [23, 24]. Besides, Brau- er et al. [25] concluded that the risk of ulnar nerve injury was higher that two crossed K- wires than that with lateral-only K-wires. After K-wire was extracted as ulnar nerve palsy, the stability for fracture depends on the residual two or three K-wires. In group of external fixa- tor, screws were inserted in lateral of humeral without ulnar nerve injury. However, external screws bring its own risks of nerve injury with potentially injury of radial nerve. When screws were inserted into the posterior aspect in proxi- mal fracture of humerus, radial nerve at the site may be injury. Therefore, the proximal screw was just above the fracture in order to reduce the risk of radial nerve injury and pro- mote the stability of fracture.
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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

All the children with suspected supracondylar fractures of the elbow were assessed for vascular and neurological status. Anteroposterior and lateral radiographs were per- formed. All displaced supracondylar fractures were admitted and the injured elbow was immobilized in an above-elbow splint with the elbow at 30°–45° of flexion and limb elevation. Pulseless viable limbs [absent radial pulse because of complete transaction, intimal tear or compression (temporary compression or reversible spasm) of brachial artery, but hand viable because of good col- laterals around elbow] were also included in the study. In all such cases a vascular surgeon was present for the sur- gery but radial pulsation appeared in all cases after close reduction and pinning. Therefore, brachial artery explo- ration was not needed for any of our cases.
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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

Fracture of Supracondylar humerus is a very common injury in children. Complications associated with this fracture warrant appropriate and optimum management of this injury. Closed reduction and percutaneous pinning with medial and lateral cross K-wires offers an excellent method to reduce and fix these fractures accurately. Some biomechanical studies advocate cross pinning technique as a more stable biomechan- ical construct. Increased time from presentation to surgery is not associated with increased morbidity from the injury or treatment complications. Early mobilization is an advantage with this treatment. The use of a medial entry pin for the treatment of paediatric supracondylar humerus fractures is safe as far as iatrogenic ulnar nerve injury and vascular complications are concerned, if an adequate technique is followed. None of the patients had any vascular compromise.
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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

distal fragment and avoid post-operative complications, especially iatrogenic nerve injuries and malunion due to loss of reduction with poor cosmetic and functional outcome. The most debated subject is the optimal pin configurations to hold the reduced fracture. Various pin configurations have been recommended for the treatment of displaced supracondylar humerus fractures on the basis of choice between the stability versus the risk of iatrogenic ulnar nerve injury. 7-10

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Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

It is a blunt medial projection of medial condyle. It is subcutaneous. It is visible in passive flexion. Its posterior smooth surface is crossed by ulnar nerve in a shallow sulcus as it enters the forearm. The ulna nerve can be rolled against the bone. To the anterior epicondylar surface forearm flexors are attached. The medial humeral border ends at medial epicondyle and is distally the medial supracondylar ridge. The common superficial flexor tendon arises from the medial epicondylar epiphysis which is wholly extracapsular. The medial condyle turns slightly backwards.
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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

the lack of support on medial column was related to the reduction loss. We selected cases that thoroughly followed the stable lateral pin fixation rule, and all the Baumann angle differences were below 10 ° . So, we tried to find any factor related to the Baumann angle change of more than average difference, and medial comminution was noted as a risk factor in the logistic regression analysis, although the dif- ference was very small. If supracondylar humerus fracture with medial comminution was fixed with lateral-only pin fixation, there is a chance of Baumann angle change until bone union. So, more stable fixation than lateral-only pin fixation will be better, and we recommend additional medial pin fixation.
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Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing

Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing

It’s our routine practice to evaluate clinically and radio- logically all patients at 1 month, at 2 or 3 months, and thereafter at 6-monthly intervals. After obtaining informed consent from patients or patients & parents, all radiographs and hospital records were reviewed; moreover, all 20 patients treated with closed reduction received an extra clinical follow-up between May and June 2012. The fol- low-up period ranged from 15 to 63 months, with a mean of 42 months. The angulation of the radial neck was measured as the angle between a line drawn parallel to the superior articular surface of the radial head and a line perpendicular to the articular surface through the radial shaft in the primary radiographs. The postoperative clinical evaluation was performed by one of the authors (F.F.) and included analysis of passive and active range of motion (ROM), radiological evaluation of alignment, functional results using the Mayo elbow performance score (MEPS), and early or late complications. Flexion and extension of elbows, pronation and supination of the forearm and the angle of the extended elbows were measured by a goni- ometer. The uninjured elbows served as controls. The last follow-up radiographs included standard anteroposterior and lateral projections of the injured elbow. All measure- ments were performed on a picture archiving and com- munication system (PACS, software Fuji Synapse). Radiologically, the reduction was considered excellent when it healed in the anatomical position; good when the radial neck angle was less than 20°; medium when the angle was between 20° and 40°; poor with an angle of more than 40°. The MEPS is one of the most commonly used physician-based elbow rating systems (Table 1). The joint’s stability was graded as stable, mildly unstable or unstable. The functional score is determined on the basis of the patient’s ability to perform normal activities of daily Fig. 1 a Radial neck fracture Judet type III. b Osteosynthesis with
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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

There were several limitations in this meta-analysis: (1) only 6 potential studies were finally included, the effect size was relative small; (2) follow-up was relatively short and thus, the potential of these management complica- tions may be underestimated; (3) the management of the K-wires was different and thus, may cause the heterogen- eity for the outcomes; (4) subgroup analysis was not performed since the number of the included studies was limited and thus, more RCTs were need to further identify the clinical outcomes of these two managements.

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Open reduction internal fixation vs non operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol

Open reduction internal fixation vs non operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol

Non-operative management of proximal humerus fractures with a period of immobilization and progressive physiother- apy is a simple, noninvasive and readily available treatment option. In a systematic review of non-operative manage- ment, Iyengar et al. [9] evaluated 12 studies (n = 650) [10–21], with a mean age of 65.0 years and a mean follow-up of 3.8 years (range of 1–10 years). Based on the Neer classification [22], there were 49% undisplaced or one-part (n = 317), 25% two-part (n = 165), 21% three-part (n = 137), and 5% four-part (n = 31) fractures. Although variable, all treatment protocols included a period of sling immobilization followed by progressive mobilization as tolerated. The mean rate of radiographic union was 98% (range 93–100%). Various functional outcome scores were used; with 6 studies (n = 272) [10, 12, 14, 19–21] showing a weighted mean Constant score of 74 (range 55–81) cor- responding to a “fair” outcome. Across all studies, a 13% complication rate was reported, with varus malunion being the most common (n = 44 or 7%). Proximal humerus avas- cular necrosis was found to be uncommon (n = 13 or 2%) [9]. In the largest included trial, Hanson et al. re- ported the functional outcomes of non-operative manage- ment through a prospective evaluation of 160 patients, with 124 patients having complete 1-year follow-up. Nearly half (53.1%) were undisplaced fractures. The aver- age Constant score was 74.3 with a mean difference be- tween the injured and contralateral shoulder of 8.2. They found an estimated median time to definitive union of 14 weeks, and a 7% risk of delayed or nonunion. Four pa- tients went on to require surgical fixation and 5 patients underwent arthroscopic decompression, with an eventual operation rate of 5.6% [12]. With a large focus on undis- placed fractures, these studies highlight that non-operative management of proximal humerus fractures can lead to satisfactory functional outcomes with modest complica- tion rates. In a report of non-operative management of displaced proximal humerus fractures, Yuksel et al. re- ported a mean Constant score of 61.3 (n = 18, eight 3-part
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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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A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

for observation. Entry points of the proximal lateral pins (the most proximal lateral pin in case of more than two lateral pins) were recorded in reference to the ossific nu- cleus of the capitellum (ONC) on both views. To deter- mine the exit point of the proximal lateral pin, we first determined and marked the upper border of the distal metaphyseal-diaphyseal junction (MDJ) region by draw- ing two perpendicular and tangential lines along the shaft of the humerus on the AP radiograph. A horizontal line (line AB) passing through the more proximal point of the two points where the two parallel lines intersected the humeral shaft was regarded as the upper border of the MDJ region (Fig. 1). The regions below and above
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Effect of osteosynthesis, primary hemiarthroplasty, and non surgical management for displaced four part fractures of the proximal humerus in elderly: a multi centre, randomised clinical trial

Effect of osteosynthesis, primary hemiarthroplasty, and non surgical management for displaced four part fractures of the proximal humerus in elderly: a multi centre, randomised clinical trial

Two previous very small randomised clinical trials com- pared treatments for displaced four-part fractures. Stable- forth[8] compared arthroplasty with non-surgical management on 32 patients. The result tended to favour surgery. Hoellen[15] compared arthroplasty with osteo- synthesis on 30 patients, but found no statistically signif- icant difference in outcome. Both trials had low power, and did not report clearly adequate concealment of patient allocation or blinding procedures. The trials were analysed and summarised in a Cochrane review[16] that emphasised that the limited evidence available does not even confirm that surgery is preferable to conservative
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Isolated fracture of the humeral trochlea: a case report and review of the literature

Isolated fracture of the humeral trochlea: a case report and review of the literature

The first description of an isolated fracture of the hu- meral trochlea was in 1853 by Laugier. Thus, the trochlea fracture is also sometimes known as Laugier’s fracture [1]. Although this description is old, these fractures remain rare. Our review of the literature identified only eight reported cases [2-9] and two lim- ited series relating respectively to two and five cases [10,11]. We report a case of an isolated fracture of the trochlea that was treated surgically. The purpose of this study is to discuss the mechanisms and the diagnostic and therapeutic issues relating to this entity.
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Proximal Humeral Fractures: Nonoperative Versus Operative Treatment

Proximal Humeral Fractures: Nonoperative Versus Operative Treatment

This was a retrospective case-control study to investi- gate differences in upper extremity specific disability be- tween patients who were and were not operatively treated for a displaced proximal humerus fracture. Displacement was defined as displacement of 1 cm or 45° of angulation between two fragments. After approval by our institu- tional review board, we used our hospital’s billing records to search the hospital PACS (picture archiving communi- cations system) database for patients with displaced frac- tures of the proximal humerus. Adult (age 18 or greater), Dutch speaking patients with an isolated displaced frac- ture of the proximal humerus between January 2004 and August 2011 and at least 6 months of follow-up and com- plete demographic information were eligible. Exclusion criteria were: 1) major musculoskeletal (pathological frac- ture) or neurological comorbidities (e.g. Parkinson dis- ease, multiple sclerosis,); 2) open fracture; 3) treatment with arthroplasty; 4) cognitive impairment (e.g. dementia, head injury, overall illness) and 5) patients with pathologi- cal fractures or associated upper limb injuries.
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Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Because of these problems with the ELA, there has been renewed interest to develop alternative techniques to manage intra-articular calcaneal fractures and minimize soft tissue complications [17,18,26,27]. Many techniques have been described over the last 10 years [26,28-30], including percutaneous fixation, arthroscopic assisted, external fixation, trans-articular, and small med- ial, posterior, lateral or a combined incision technique [17,26-30]. The less invasive approach has been described such as the STA [17,18]. These techniques all attempt to minimize the risk of operative complications, while still allowing good fracture reduction. We focused here on our studies describing the STA.
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