BACKGROUND The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning(CRPP). However, there is debate regarding the technique that is utilized, whether...BACKGROUND The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning(CRPP). However, there is debate regarding the technique that is utilized, whether crossed or lateral pinning, and the number of pins used.AIM To compare the functional and radiological outcomes of lateral and cross pinning in the management of humeral supracondylar fracture.METHODS A retrospective analysis was performed on 101 patients who were surgically managed by either one of the CRPP techniques from 2015 to 2019. Several clinical parameters were taken into account, including pre-and post-intervention Baumann angle, as well as scores for pain, range of motion, function, and stability. Statistical analysis was performed to study the outcomes of the utilized techniques.RESULTS Amongst our study sample, which included 63 males and 38 females with a mean age of 5.87 years, about one-third of the patients underwent crossed pinning fixation configuration and the remaining two-thirds were managed by lateral pinning configuration. Similar results were obtained in the two groups with no statistical difference regarding Mayo elbow performance scores(MEPS) and Baumann angle. The mean MEPS in the lateral and crossed pinning groups were 93.68 + 8.59 and 93.62 + 9.05, respectively. The mean Baumann angle was 72.5° + 6.46 in the lateral group and 72.3° + 4.70 in the crossed-pinning group(P = 0.878).CONCLUSION Both lateral pinning and crossed pinning fixation configuration for displaced pediatric supracondylar humeral fractures provide similar functional and radiological outcomes.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Environmental conditions are effective on childhood su</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pracondylar humerus fractures. In this study</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we evaluated the relationship between weather conditions and these fractures. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We started </span><span style="font-family:Verdana;">this study following the approval of a non-interventional research ethics</span><span style="font-family:Verdana;"> committee. Patients (<16 years) who applied to the hospital between January 2013 </span><span style="font-family:Verdana;">and July 2018 with supracondylar humerus fracture</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> were included in the</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> study. The hospital’s PROBEL system was used to diagnose (International Classification of the Diseases, ICD, S42.4) radiological images and patient information. Information on the weather conditions in the day and time period, in </span><span style="font-family:Verdana;">which supracondylar humerus fracture occurred, was obtained from TR</span><span style="font-family:Verdana;"> (Turkey) Ministry of Agriculture and Forestry General Directorate of Mete</span><span style="font-family:Verdana;">orology. The relationship between supracondylar fracture and daily weather </span><span style="font-family:Verdana;">conditions (wind, air temperature, cloudiness, and</span><span style="font-family:Verdana;"> sea</span><span><span style="font-family:Verdana;">son) was analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Most of the patients (n = 76, 40.6%, p < 0.05)</span></span><span style="font-family:Verdana;"> were fractures occurring under cloudless weather conditions. Fractures were con</span><span style="font-family:Verdana;">centrated with a second frequency in cloudy weather over 60%, except for</span><span style="font-family:Verdana;"> cloud</span><span style="font-family:Verdana;">less weather conditions (n = 51, 27.3%, p < 0.05). In the summer months </span><span style="font-family:Verdana;">when the air temperature was high, the number of fractures was higher (n = 62, 33.2%, p < 0.05) and less in the winter months (n = 24, 12.8%, p < 0.05). In hot weather conditions where the daily average temperature was above 20<span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span>C, supracondylar humerus fractures were observed more (n = 101, 54%) and less than 10<span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span>C (n = 43, 23%, p < 0.05). Increased incidence of fractures was observed in the </span><span><span style="font-family:Verdana;">presence of wind (n = 4, 2.1%, p < 0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Supracondylar</span></span><span style="font-family:Verdana;"> humerus fractures are </span><span style="font-family:Verdana;">common in children. Environmental conditions (temperature, wind, and</span><span style="font-family:Verdana;"> season) can be effective in the occurrence of these fractures.</span></span></span></span>展开更多
Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children...Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.展开更多
Postoperative early rehabilitation training for supracondylar fracture of femur aids in accelerating the healing of fractures with shorter recovery periods. Presently, clinical studies on post-operative early weight t...Postoperative early rehabilitation training for supracondylar fracture of femur aids in accelerating the healing of fractures with shorter recovery periods. Presently, clinical studies on post-operative early weight training are still in the nascent stages. The weight bearing capacity at different healing stages typically depends on clinical experience and there is a lack of standards to quantify the weight that would be conducive to the healing of fractures. In this paper, a 3D geometric model of the femur is obtained using imaging data, a locking plate fixation model of a simple supracondylar fracture of the femur, which considers the angle and spatial direction of the fracture surface, is established, the stress distribution and load transmission mechanism of the fracture fixation model on a single leg standing posture are studied and the weight bearing capacity of a standing single leg at the early stage of fracture is given. This provides the basis for objective quantification of postoperative early weight bearing capacity.展开更多
To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who s...To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K wires fixation Results. All patients’ K wires were removed at 4 weeks post operation Their elbow function regained at 8 weeks The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed very well without any permanent complications Two transient nerves palsy,ulnar and radial nerve each, recovered completely at 12 weeks and 16 weeks post operation respectively Conclusion. Closed reduction and percutaneous K wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children展开更多
Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a media...Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center. Materials & Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software. Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p = 0.010) in the number of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III—Retrospective cohort study.展开更多
Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classifi...Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.展开更多
BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the eld...BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.展开更多
BACKGROUND Supracondylar humerus fractures account for more than 60%of all elbow fractures and about 1/5 of all pediatric fractures.Unfortunately,these fractures can be associated with risk of complications including ...BACKGROUND Supracondylar humerus fractures account for more than 60%of all elbow fractures and about 1/5 of all pediatric fractures.Unfortunately,these fractures can be associated with risk of complications including neurovascular injuries,malunions and limb deformities.Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019.The data extracted included demographic data,fracture characteristics,surgical data,and follow-up outcomes.The collected data was analyzed and P values of<0.05 were considered statistically significant.RESULTS Of the cohort,11%of patients had documented post-operative complications,of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction.While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons,this did not reach statistical significance.CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures,we found a higher complication rate when surgeries were not performed during working hours.Surgeon level and training had no significant effect on the risk of post-operative complications.展开更多
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar...Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.展开更多
Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The object...Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The objective of our study was to evaluate the results of supracondylar fractures of the humerus treated by this method in our department. This was a descriptive, longitudinal study with the prospective collection over a period of 12 months from May 2018 to April 2019. It focused on children aged 0 to 15 years treated in the Orthopedic Traumatology Department of the CHU of Kati for a supracondylar fracture of the humerus in extension. A minimum follow-up period of 6 months was necessary for inclusion. 12 patients were collected. The sociodemographic, anatomopathologic, therapeutic and evolutionary aspects were studied. The results were evaluated according to Flynn’s criteria. The male sex was predominant with a ratio of 2. The average age was 5.5 years. The average admission time was 12.5 hours. Domestic accidents were the main etiology (66.66%) and Type II fracture was the most frequent with 58.33%. The duration of immobilization was 42 days for 11 patients. Complications were 1 case of secondary displacement and 1 case of 12˚ flexion deficit. The average Baumann angle was 72˚. The result was satisfactory for all our patients. Supracondylar fractures of the humerus are common in children, especially boys. The method of Blount when it is well carried out by respecting the indications gives good results.展开更多
Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controver...Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.展开更多
To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients wit...To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients with severe osteoporosis or with nonunion site close to the artificial surface,the head of the buttress plate was added,making the screws to fixate easily.Iliac bone autograft including iliac block and scum of spongy bone was used in order to fully arouse the inductive and conductive effect of the graft.Continuous postoperative passive motion (CPM) was performed for a short period,and the active and passive motion were intensively advised for one year long.The cases were followed up from 12 to 70 months (mean 34 months).Results All cases were healed,with average healing time of five months (3～6 months).The motion range for the knee joint was increased from 73 degrees (5～135 degrees) to 97 degrees (30～135 degrees).Excellent and good results were achieved in 13 cases,satisfactory in four and poor in one.Conclusion DCS with rigid fixation and compression effect,combined with porous condylar plate if necessary,with iliac bone autograft and long period of post-operative exercises of the knee joint,provides one efficacious technique for treating the supracondylar non-unions of the femur.11 refs,2 figs.展开更多
To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female...To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.展开更多
Purpose： This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural ...Purpose： This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries. Methods： All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years. Results： We analysed a total of 263 patients and most of the fractures were seen in 5-8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 （23.95%） and type 2 （21.67%）. Conclusion： Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.展开更多
目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供...目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供参考。方法:全面检索PubMed、Embase、Web of Science和the Cochrane Library建库以来至2023-01-06发表的相关随机对照试验,比较儿童肱骨髁上骨折内外侧交叉固定和单纯外侧固定两种术式的疗效差异,主要观察指标是影像学结果(Baumann角丢失、提携角丢失)、肘关节功能和常见并发症(医源性尺神经损伤、针道感染)。结果:①共纳入18项研究;②两组Baumann角丢失(P=0.47)、提携角丢失(P=0.47)情况相比无统计学差异;外侧固定组与内外侧交叉固定组关节功能恢复评分优秀的患儿比例分别为70.7%和74.9%,差异无显著性意义(P=0.12);两组在针道感染发生率上同样无统计学差异(P=0.9),但内外侧交叉固定组医源性尺神经损伤的风险更高(P=0.02);③然而,当采用小切口联合探查时,内外侧交叉固定组尺神经损伤的频率与外侧固定组相比无统计学差异(P=0.2);④在GartlandⅢ型亚组中,两组在关节功能恢复评分优秀率(P=0.13)、尺神经损伤(P=0.13)和针道感染(P=0.61)方面均无统计学差异。结论:荟萃分析结果显示,与外侧固定技术相比,内外侧交叉固定方法更容易造成前臂的医源性神经损伤,但同时也增加了结构的稳定性。不过,通过小切口方法联合内外侧交叉固定似乎可以降低患者神经损伤的风险。因此,儿童肱骨髁上骨折治疗采用小切口结合内外侧交叉固定可能是一种既保证结构稳定、又安全的固定方法。展开更多
Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supraco...Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.展开更多
文摘BACKGROUND The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning(CRPP). However, there is debate regarding the technique that is utilized, whether crossed or lateral pinning, and the number of pins used.AIM To compare the functional and radiological outcomes of lateral and cross pinning in the management of humeral supracondylar fracture.METHODS A retrospective analysis was performed on 101 patients who were surgically managed by either one of the CRPP techniques from 2015 to 2019. Several clinical parameters were taken into account, including pre-and post-intervention Baumann angle, as well as scores for pain, range of motion, function, and stability. Statistical analysis was performed to study the outcomes of the utilized techniques.RESULTS Amongst our study sample, which included 63 males and 38 females with a mean age of 5.87 years, about one-third of the patients underwent crossed pinning fixation configuration and the remaining two-thirds were managed by lateral pinning configuration. Similar results were obtained in the two groups with no statistical difference regarding Mayo elbow performance scores(MEPS) and Baumann angle. The mean MEPS in the lateral and crossed pinning groups were 93.68 + 8.59 and 93.62 + 9.05, respectively. The mean Baumann angle was 72.5° + 6.46 in the lateral group and 72.3° + 4.70 in the crossed-pinning group(P = 0.878).CONCLUSION Both lateral pinning and crossed pinning fixation configuration for displaced pediatric supracondylar humeral fractures provide similar functional and radiological outcomes.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Environmental conditions are effective on childhood su</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pracondylar humerus fractures. In this study</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we evaluated the relationship between weather conditions and these fractures. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We started </span><span style="font-family:Verdana;">this study following the approval of a non-interventional research ethics</span><span style="font-family:Verdana;"> committee. Patients (<16 years) who applied to the hospital between January 2013 </span><span style="font-family:Verdana;">and July 2018 with supracondylar humerus fracture</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> were included in the</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> study. The hospital’s PROBEL system was used to diagnose (International Classification of the Diseases, ICD, S42.4) radiological images and patient information. Information on the weather conditions in the day and time period, in </span><span style="font-family:Verdana;">which supracondylar humerus fracture occurred, was obtained from TR</span><span style="font-family:Verdana;"> (Turkey) Ministry of Agriculture and Forestry General Directorate of Mete</span><span style="font-family:Verdana;">orology. The relationship between supracondylar fracture and daily weather </span><span style="font-family:Verdana;">conditions (wind, air temperature, cloudiness, and</span><span style="font-family:Verdana;"> sea</span><span><span style="font-family:Verdana;">son) was analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Most of the patients (n = 76, 40.6%, p < 0.05)</span></span><span style="font-family:Verdana;"> were fractures occurring under cloudless weather conditions. Fractures were con</span><span style="font-family:Verdana;">centrated with a second frequency in cloudy weather over 60%, except for</span><span style="font-family:Verdana;"> cloud</span><span style="font-family:Verdana;">less weather conditions (n = 51, 27.3%, p < 0.05). In the summer months </span><span style="font-family:Verdana;">when the air temperature was high, the number of fractures was higher (n = 62, 33.2%, p < 0.05) and less in the winter months (n = 24, 12.8%, p < 0.05). In hot weather conditions where the daily average temperature was above 20<span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span>C, supracondylar humerus fractures were observed more (n = 101, 54%) and less than 10<span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span>C (n = 43, 23%, p < 0.05). Increased incidence of fractures was observed in the </span><span><span style="font-family:Verdana;">presence of wind (n = 4, 2.1%, p < 0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Supracondylar</span></span><span style="font-family:Verdana;"> humerus fractures are </span><span style="font-family:Verdana;">common in children. Environmental conditions (temperature, wind, and</span><span style="font-family:Verdana;"> season) can be effective in the occurrence of these fractures.</span></span></span></span>
基金supported by Program of the National Natural Science Foundation of China(No.82074233)Scientific Research Foundation for Advanced Talents,Xiang’an Hospital of Xiamen University(No.PM201809170009).
文摘Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.
基金The work was supported by the National Natural Science Foundation of China (Grants 11672297, 11872273, and 11472191)the Strategic Priority Research Program of the Chinese Academy of Sciences (Grant XDB22020200)the Opening Fund of the State Key Laboratory of Nonlinear Mechanics.
文摘Postoperative early rehabilitation training for supracondylar fracture of femur aids in accelerating the healing of fractures with shorter recovery periods. Presently, clinical studies on post-operative early weight training are still in the nascent stages. The weight bearing capacity at different healing stages typically depends on clinical experience and there is a lack of standards to quantify the weight that would be conducive to the healing of fractures. In this paper, a 3D geometric model of the femur is obtained using imaging data, a locking plate fixation model of a simple supracondylar fracture of the femur, which considers the angle and spatial direction of the fracture surface, is established, the stress distribution and load transmission mechanism of the fracture fixation model on a single leg standing posture are studied and the weight bearing capacity of a standing single leg at the early stage of fracture is given. This provides the basis for objective quantification of postoperative early weight bearing capacity.
文摘To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K wires fixation Results. All patients’ K wires were removed at 4 weeks post operation Their elbow function regained at 8 weeks The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed very well without any permanent complications Two transient nerves palsy,ulnar and radial nerve each, recovered completely at 12 weeks and 16 weeks post operation respectively Conclusion. Closed reduction and percutaneous K wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children
文摘Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center. Materials & Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software. Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p = 0.010) in the number of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III—Retrospective cohort study.
文摘Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.
文摘BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.
基金Ethical approval was obtained from the Imam Abdulrahman Bin Faisal University review board(IRB-UGS-2019-01-333)。
文摘BACKGROUND Supracondylar humerus fractures account for more than 60%of all elbow fractures and about 1/5 of all pediatric fractures.Unfortunately,these fractures can be associated with risk of complications including neurovascular injuries,malunions and limb deformities.Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019.The data extracted included demographic data,fracture characteristics,surgical data,and follow-up outcomes.The collected data was analyzed and P values of<0.05 were considered statistically significant.RESULTS Of the cohort,11%of patients had documented post-operative complications,of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction.While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons,this did not reach statistical significance.CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures,we found a higher complication rate when surgeries were not performed during working hours.Surgeon level and training had no significant effect on the risk of post-operative complications.
文摘Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.
文摘Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The objective of our study was to evaluate the results of supracondylar fractures of the humerus treated by this method in our department. This was a descriptive, longitudinal study with the prospective collection over a period of 12 months from May 2018 to April 2019. It focused on children aged 0 to 15 years treated in the Orthopedic Traumatology Department of the CHU of Kati for a supracondylar fracture of the humerus in extension. A minimum follow-up period of 6 months was necessary for inclusion. 12 patients were collected. The sociodemographic, anatomopathologic, therapeutic and evolutionary aspects were studied. The results were evaluated according to Flynn’s criteria. The male sex was predominant with a ratio of 2. The average age was 5.5 years. The average admission time was 12.5 hours. Domestic accidents were the main etiology (66.66%) and Type II fracture was the most frequent with 58.33%. The duration of immobilization was 42 days for 11 patients. Complications were 1 case of secondary displacement and 1 case of 12˚ flexion deficit. The average Baumann angle was 72˚. The result was satisfactory for all our patients. Supracondylar fractures of the humerus are common in children, especially boys. The method of Blount when it is well carried out by respecting the indications gives good results.
文摘Background: Supracondylar fractures of the humerus are among the most common type of pediatric fractures. The outcome of severely displaced supracondylar fracture of the humerus in children subjected to wide controversies in term of safety, functional and cosmetic outcome. Closed reduction and percutaneous pinning is now considered as the gold standard rule, but open reduction still applicable in certain cases where intraoperative imaging is not available, in comminuted lateral column fractures and uneducable fractures. Aim of the Study: To compare the outcome (functional and cosmetic) of anterior (Henry) approach with the posterior (Campbell) approach used in two groups of patients’ sustained displaced supracondylar fractures. Patients and Methods: This prospective study was performed on 48 pediatric patients who were been admitted to the Emergency Hospital in Sulaimani province sustained displaced supracondylar humeral fractures and treated during the period from the first of October 2009 to the thirty-one of January 2011. The study included 28 boys, 20 girls;their mean age was 7.5 years;their ages range 2 - 13 years. We used the modified Gartland classification to assess the fractures displacement and only Gartland type II B and III were included and managed operatively by open reduction and internal fixation with 2 crossed K-wires. Follow up continued for 6 months and the results finally assessed using Flynn’s criteria. Results: According to the criteria of Flynn et al., 20 patients (83.3%) treated by the anterior approach had excellent functional results while 4 patients (16.7%) had good functional results. While those treated by the posterior approach, 16 patients (66.6%) had excellent functional results, 6 patients (25%) had good results and 2 (8.3%) patients had fair outcome. Cosmetic results were excellent in 22 patients in the anterior approach group and 20 patients in the posterior approach group. Conclusion: Posterior Campbell approach is simpler than anterior Henry approach, but it creates additional soft tissue damage that can affect the circulatory status and hence possible osteonecrosis of the trochlea and a higher percentage of limitation in joint mobility. While the anterior approach is technically more demanding, but it gives better functional results.
文摘To evaluate the result of dynamic condylar screw (DCS) and iliac bone autograft for treating supracondylar nonunions.Methods For 18 supracondylar nonunions,DCS was used as the internal fixation device.For patients with severe osteoporosis or with nonunion site close to the artificial surface,the head of the buttress plate was added,making the screws to fixate easily.Iliac bone autograft including iliac block and scum of spongy bone was used in order to fully arouse the inductive and conductive effect of the graft.Continuous postoperative passive motion (CPM) was performed for a short period,and the active and passive motion were intensively advised for one year long.The cases were followed up from 12 to 70 months (mean 34 months).Results All cases were healed,with average healing time of five months (3～6 months).The motion range for the knee joint was increased from 73 degrees (5～135 degrees) to 97 degrees (30～135 degrees).Excellent and good results were achieved in 13 cases,satisfactory in four and poor in one.Conclusion DCS with rigid fixation and compression effect,combined with porous condylar plate if necessary,with iliac bone autograft and long period of post-operative exercises of the knee joint,provides one efficacious technique for treating the supracondylar non-unions of the femur.11 refs,2 figs.
文摘To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.
文摘Purpose： This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries. Methods： All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years. Results： We analysed a total of 263 patients and most of the fractures were seen in 5-8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 （23.95%） and type 2 （21.67%）. Conclusion： Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.
文摘目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供参考。方法:全面检索PubMed、Embase、Web of Science和the Cochrane Library建库以来至2023-01-06发表的相关随机对照试验,比较儿童肱骨髁上骨折内外侧交叉固定和单纯外侧固定两种术式的疗效差异,主要观察指标是影像学结果(Baumann角丢失、提携角丢失)、肘关节功能和常见并发症(医源性尺神经损伤、针道感染)。结果:①共纳入18项研究;②两组Baumann角丢失(P=0.47)、提携角丢失(P=0.47)情况相比无统计学差异;外侧固定组与内外侧交叉固定组关节功能恢复评分优秀的患儿比例分别为70.7%和74.9%,差异无显著性意义(P=0.12);两组在针道感染发生率上同样无统计学差异(P=0.9),但内外侧交叉固定组医源性尺神经损伤的风险更高(P=0.02);③然而,当采用小切口联合探查时,内外侧交叉固定组尺神经损伤的频率与外侧固定组相比无统计学差异(P=0.2);④在GartlandⅢ型亚组中,两组在关节功能恢复评分优秀率(P=0.13)、尺神经损伤(P=0.13)和针道感染(P=0.61)方面均无统计学差异。结论:荟萃分析结果显示,与外侧固定技术相比,内外侧交叉固定方法更容易造成前臂的医源性神经损伤,但同时也增加了结构的稳定性。不过,通过小切口方法联合内外侧交叉固定似乎可以降低患者神经损伤的风险。因此,儿童肱骨髁上骨折治疗采用小切口结合内外侧交叉固定可能是一种既保证结构稳定、又安全的固定方法。
文摘Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.
