Close reduction and percutaneous pinning in displaced supracondylar humerus fractures in children

Abstract

Background: Displaced supracondylar fractures of the humerus in children are common pediatric injuries treated by orthopedic surgeons. They also have a high rate of complications if not reduced and stabilized in optimal position which may lead to serious neurovascular injuries and residual deformity. Amongst the various methods used for treating these fractures, closed reduction and percutaneous pinning has shown improved results.

Method: Between March 2005 and April 2010, 277 cases of supracondylar humeral fractures (Gartland grade II and III) with less then 1 week old were included in this study. They were treated with closed reduction and percutaneous pinning with crossed Kirschner wires under image intensifier control. Clinical outcome were assessed according to Flynn's criteria.

Results: The mean age at the time of operation was 6 years (range 2-10 years) and the average duration of follow-up was 4.6 years (range 2.1-7.2 years). The Flynn's criteria were excellent in 202, good in 68, fair in 5 and only 2 with poor results.

Conclusion: Closed reduction and percutaneous pinning is a sound and effective treatment for displaced supracondylar fractures.

Keywords: Closed reduction; Displaced supracondylar fractures; Percutaneous pinning.

Fig. 1

(a) Reduction by traction in extension under general anaesthesia. (b) Passing of K- wires under C-arm control.

Fig. 2

(a) Passing of K-wires under C-arm control (lateral view). (b) Passing of K-wires under C-arm control (A-P view).

Fig. 3

(a) Gartland grade-III supracondylar fracture A-P and lateral view. (b) Close reduction and cross K-wire fixation (A-P view). (c) Close reduction and cross K-wire fixation (lateral view).

Fig. 4

(a) Gartland grade-III supracondylar fracture (A-P view). (b) Gartland grade-III supracondylar fracture (lateral view). (c) Close reduction and cross K-wire fixation A-P and lateral view.