Comparison of Fixation of supracondylar humeral fractures in children by lateral cross-wiring technique versus traditional lateral pinning | ||
| Sohag Medical Journal | ||
| Article 41, Volume 22, Issue 1, January 2018, Pages 265-271 PDF (307.26 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/smj.2018.41770 | ||
| Authors | ||
| Abdelrahman A Sadek1; Mostafa Elsayed2; Hussam Eldin M Elazab3; Hassan Hamdy Abdel Rahman1 | ||
| 1Department of Orthopedic, Faculty of Medicine, Sohag University. | ||
| 2Department of Orthpaedic and Traumatology , Faculty of Medicine, Sohag University. | ||
| 3Department of orthopedics and traumatology, Sohag University, Egypt. | ||
| Abstract | ||
| Introduction The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The aim of this study was to study the results of a cross-wiring technique, achieved solely from the lateral side, in an effort to reduce the risk of ulnar nerve injury. Conclusion there was no significant difference between lateral cross-wiring technique and traditional lateral pinning as regard postoperative clinical results and radiological results. Introduction Supracondylar fractures of the humerus in children accounts for 60% of all fractures around the elbow. (1) It represents 4 - 6.5% of all paediatric fractures. In treatment of non-displaced Type I fractures simple immobilization with a posterior splint applied at 60-90o of elbow flexion is preferred. (2) Currently, the treatment of choice for type II fractures is operative reduction and pinning rather than cast. (3) Most cases of type III fractures require operative reduction and pinning. The results of type III fractures treated with closed reduction and cast immobilization are not as good as the results of pinning. (4) There are various options for the pattern of K-wire fixation of displaced supracondylar fractures. Studies found the greatest resistance to rotation occurred with medial-lateral cross pinning. (5) The second most stable pattern was fixation utilizing three lateral diverging pins. The least stable was fixation with two lateral pins, which cross at the fracture site. While medial-lateral cross pinning has the greatest resistance; the disadvantage is the risk of ulnar nerve injury. (6) Lateral pinning is recommended (7) to avoid iatrogenic ulnar nerve injury that can occur with medial lateral cross pinning. Although iatrogenic ulnar nerve injuries usually resolve, several permanent iatrogenic ulnar nerve injuries have been described. (8) Closed reduction and lateral cross-wiring technique with ascending and descending K-wires is an effective method to treat type II and III supracondylar fractures in children. Regardless of stability, this method can be used to avoid iatrogenic ulnar nerve injuries. (9) Aim of the work The aim of this work is to assess clinical results of fixation of supracondylar humeral fractures by lateral cross-pinning versus traditional lateral pinning in children. | ||
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| References | ||
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1. Noaman HH, M.D. Microsurgical reconstruction of brachial artery injuries in displased supracondylar fracture humerus in children. Microsurgery. 2006, 26, pp. 498-505.
2. J., Charnley. Closed Treatment of Common Fractures. Edinburgh: Churchill Livingstone. 1961, pp. 105-115.
3. Battaglia TC, Armstrong DG, Schwend RM. Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop. 2002, 22 (4), pp. 431-439.
4. Cramer KE, Devito DP, Green NE. Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. J Orthop Trauma. 1992, 6(4), pp. 407-412.
5. Zionts LE, McKellop HA, Hathaway. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1994, 76, pp. 253–256.
6. Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998, 18, pp. 43–45.
7. Ariño VL, Lluch EE, Ramirez AM, et al. Percutaneous fixation of supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1977, 59(7), pp. 914-916.
8. Ramachandran M, Birch R, Eastwood DM. Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children. The experience of a specialist referral centre. J Bone Joint Surg Br. 2006, 88(1), pp. 90-94.
9. Oliver Eberhardt, Francisco Fernandez, Thomas Ilchmann & Klaus Parsch. Cross pinning of supracondylar fractures from a lateral approach. Stabilization achieved with safety. J Child Orthop. 2007, 1, pp. 127–133.
10. Flynn, J.C. and Zink, W.P.: In: MacEwen GD, Kasser JR,Heinrich SD, eds. Pediatric fractures. A practical approach to assessment and treatment. Baltimore: Williams and Wilkins. 1993, pp. 133-164.
11. Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS.A. systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2008, Vol. 2, 27, pp. 181-186.
12. Eberhardt O, Fernandez F, Ilchmann T, Parsch K. Cross pinning of supracondylar fractures from a lateral approach. Stabilization achieved with safety. J Child Orthop. 2007, 1, pp. 127-133.
13. Gangadharan S, Rathinam B, Madhuri V. Radial nerve safety in Dorgan's lateral cross-pinning of the supracondylar. J Pediatr Orthop B. 2014, 6, pp. 579-583.
14. Queally JM, Paramanathan N, Walsh JC, Moran CJ, Shannon FJ, D'Souza LG. Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review. j. injury. 2010, 6.
15. Shannon FJ, Mohan P, Chacko J, D’Souza LG. Dorgan’s percutaneous lateral cross wiring of supracondylar fractures of the humerus in children. J Pediatr Orthop. 2004, 24, pp. 376-379.
16. Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop. 2002, 22, pp. 440–443.
17. Sudeep Vaidya, Achyut Rajbhandari, Nabees Pradhan, Suman Shrestha. Percutenious Fixation Of Displaced Supracondylar Fracture In Children Comparing Lateral With Medial And Lateral Pin. J Pediatr Orthop. 2009, 13, pp. 521-555.
18. El-Adl WA, El-Said MA, Boghdady GW, Ali AM. Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique. Strategies Trauma Limb Reconstr. 2008, Vol. 3, pp. 1–7.
19. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar fractures of the humerus in children. J Pediatr Orthop. 1995, 15, pp. 440–443.
20. Queally JM, Paramanathan N, Walsh JC, Cathal J Moran CJ, Fintan J, et al. Dorgan’s lateral cross-wiring of supracondylar fractures of the humerus in children: a retrospective review. Injury. 2010, 41, pp. 568–571.
21. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am. 1974, Vol. 2, 56, pp. 263-272. | ||
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