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. 2020 Jul;34(7):e245-e249.
doi: 10.1097/BOT.0000000000001735.

Can We Estimate the Amount of Malrotation in Supracondylar Humerus Fractures After CRPP?

Pooja Prabhakar  1 , William A Pierce  2 , Karen D Standefer  2 , Christine A Ho  3
Affiliations

Can We Estimate the Amount of Malrotation in Supracondylar Humerus Fractures After CRPP?

Pooja Prabhakar et al. J Orthop Trauma. 2020 Jul.

Abstract

Background: Acceptable amounts of malrotation after CRPP for pediatric supracondylar humerus fracture (SCHFx) have yet to be defined. This is an attempt to correlate radiographic parameters of a malrotated SCHFx with degrees of rotational malalignment to assist intraoperative assessment of reduction.

Methods: 3D models of a left distal humerus were printed, simulating a transverse SCHFx with 5, 10, 15, 20, 25, and 30 degrees of malrotation. Four different scenarios were developed: (1) lateral cortical axis of rotation, (2) medial cortical axis of rotation, (3) centroid of the humerus longitudinal axis with the medial condyle rotated posteriorly, and (4) centroid of the humerus longitudinal axis with the medial condyle rotated anteriorly. Anteroposterior and lateral fluoroscopic views were taken with a consistent image profile. Five observers measured the amount of metaphyseal overhang on the lateral view and the width of the distal humerus just proximal to the fracture to establish amount of overhang as a percentage of distal humerus width. Regression analysis established "best fit" lines for the 4 scenarios. Ten observers used the observed characteristics of each type of malrotation and "best fit" lines to estimate axis and degrees of malrotation using the same fluoroscopy of the 24 models.

Results: The intraclass correlation coefficient of reliability for percentage of metaphyseal overhang ranged from 0.775 to 0.987. Observers correctly predicted axis of malrotation in 76% and correctly predicted amount of malrotation in 75% of models.

Conclusions: Estimation of axis of malrotation and degrees of malrotation within 5 degrees in SCHFx can be predicted in 75% of our 3D printed models.

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References

    1. Khoshbin A, Leroux T, Wasserstein D, et al. The epidemiology of paediatric supracondylar fracture fixation: a population-based study. Injury. 2014;45:701–708.
    1. Skaggs DL, Hale JM, Bassett J, et al. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83:735–740.
    1. Wilkins KE. Supracondylar fractures: what's new? J Pediatr Orthop B. 1997;6:110–116.
    1. Badhe NP, Howard PW. Olecranon screw traction for displaced supracondylar fractures of the humerus in children. Injury. 1998;29:457–460.
    1. Nacht JL, Ecker ML, Chung SM, et al. Supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning. Clin Orthop Relat Res. 1983;203–209.

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