Our results of surgical treatment of supracondylar humeral fractures in children

Öz

Objective: The second most common pediatric age fracture after the forearm fractures is distal humeral fractures. The aim of the current study is to retrospectively evaluate the results of the surgical treatment of pediatric supracondylar fractures in our clinic and compare it to the literature. Methods: During the period between 2006-2011 54 patients having supracondylar humeral fractures who were surgically treated with open reduction and crossed medial and lateral K wire fixation through posterior approach in our institution included in the study. The sex, etiology and type of the fracture, accompanying injuries, postoperative complications, radiologic parameters, cosmetic and functional results were evaluated. Results: 38 (70,4%) male and 16 (29,6%) female patients were evaluated with a mean age of 5.51 (range;1–11) years. The mean length of hospital stay was 2,29 days. The average follow up was 140 weeks. There was no iatrogenic vascular and nerve injuries. Pin tract infection and heterotopic ossification were observed only in one patient respectively. The functional results were excellent in 90,7%, good in 9,3% and cosmetic results were 90,7 excellent, 5,6% good, 1,9% satisfied, 1,9% bad according to the Flynn criteria. Conclusion: When taking into consideration the duration of hospital stay, the rate of neurovascular complication, the functional and cosmetic results it seems that treating the supracondylar humeral fractures using the posterior approach with crossed medial and lateral K-wire is a safe and effective method.

Anahtar Kelimeler

• Flynn criteria, supracondylar fractures, open reduction, children

Our results of surgical treatment of supracondylar humeral fractures in children

Öz

Amaç: Çocuklarda humerus alt uç kırıkları, ön kol kırıklarından sonra ikinci en sık görülen kırıklardır. Bu çalışmanın amacı, kliniğimizde cerrahi olarak tedavi edilen çocuk suprakondiler humerus kırıklarında uygulanan tedavi yöntemimizi değerlendirmek ve literatürle karşılaştırmaktır.Yöntemler: 2006 ve 2011 yılları arasında kliniğimizde tedavi edilen 54 suprakondiler kırıklı hasta değerlendirmeye alındı. Çalışmada hastaların demografik verileri, kırığın oluş nedenleri, kırık tipleri, eşlik eden yaralanmalar, postoperatif komplikasyonlar, radyolojik parametreler, kozmetik ve fonksiyonel sonuçlar değerlendirildi.Bulgular: 38 erkek (%70,4) ve 16 kız hasta çalışmaya dahil edildi. Ortalama yaş 5,51 olarak bulundu. Hastanede ortalama yatış süresinin 2,29 gün yine ortalama takip süresinin ise 140 hafta olduğu görüldü. İyatrojenik damar ve sinir yaralanmasına rastlanmadı. Bir hastada çivi dibi enfeksiyonu diğer bir hastada ise heterotopik ossifikasyon saptandı. Flynn kriterlerine göre fonksiyonel sonuçlar %90, 7 mükemmel, %9,3 iyi; kozmetik sonuçlar ise %90, 7 mükemmel, %5,6 iyi, %1,9 orta, %1,9 kötü olarak bulundu. Sonuç: Çocuklarda suprakondiler humerus kırıklarında hastanede yatış süresi, nörovasküler komplikasyonlar, fonksiyonel ve kozmetik sonuçlar göz önüne alındığında posterior yaklaşım ile medial ve lateralden çapraz K-teli ile tespitin güvenli ve etkin bir yöntem olduğu görüldü

Anahtar Kelimeler

• Flynn kriterleri, suprakondiler kırıklar, açık redüksiyon, çocuklar

Kaynakça

1. Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983;202:1-109.
2. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracon- dylar humerus fractures. J Pediatr Orthop 1998;18:38-42.
3. Ege R. Kırıklar, eklem ve diğer yaralanmalar. Travmatoloji 5. Baskı cilt 2. Ankara Bizim Büro Basımevi; 2002.
4. Kumar R, Kiran EK, Malhotra R, et al. Surgical management of the severely displaced supracondylar fracture of the hu- merus in children. Injury 2002;33:517-522.
5. Cheng JC, Lam TP, Shen WY. Closed reduction and percuta- neous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 1995;9:511- 515.
6. Aktekin CN, Toprak A, Ozturk AM, et al. Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures. J Pediatr Orthop B 2008;17:171-178.
7. France J, Strong M. Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop 1992;12:494-498.
8. Shrader MW. Pediatric supracondylar fractures and pe- diatric physeal elbow fractures. Orthop Clin North Am 2008;39:163-171

9. Flynn JC, Matthews JG, Benoit RL. Blind pinning of dis- placed supracondylar fractures of the humerus in children. Sixteen years experience with long-term follow-up. J Bone Joint Surg Am 1974;56:263–272.
10. Işık C, Çakıcı H, Köse KÇ, et al. Fractures of the distal radius in children: A retrospective evaluation Dicle Med J 2012; 39:179-183.
11. Schneidmueller D, Boettger M, Laurer H, et al. Distal hu- merus fractures in children. Orthopade 2013;42:977-985
12. Wu J, Perron AD, Miller MD, et al. Orthopedic pitfalls in the ED: pediatric supracondylar humerus fractures. Am J Emerg Med 2002;20:544-550.
13. Kabukçuoğlu Y, Özturk L, Bulut G, et al. Çocuk humerus suprakondiler humerus kırıklarında kırıklarında açık re- pozisyon ve minimal osteosentez ile tedavi. Acta Orthop Traumatol Turc 1993;27:243-247.
14. Kalenderer Ö, Gürcü T, Reisoğlu, et al. H. Acil servise kırık nedeni ile başvuran çocuk hastalarda kırık sıklığı ve dağılımı. Acta Orthop Traumatol Turc 2006; 40:384-387.
15. Leet AI, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pedi- atr Orthop 2002;22:203-207.
16. Iyengar SR, Hoffinger SA, Townsend DR. Early versus de- layed reduction and pinning of type III displaced supracon- dylar fractures of the humerus in children: A comparative study. J Orthop Trauma 1999;13:51–55.
17. Gadgil A, Hayhurst C, Maffulli N, et al. Elevated, straight- arm traction for supracondylar fractures of the humerus in children. J Bone Joint Surg Br 2005;87:82-87.
18. Mulhall KJ, Abuzakuk T, Curtin W, et al. Displaced supra- condylar fractures of the humerus in children. Int Orthop 2000;24:221-223.
19. Mehserle WL, Meehan PL. Treatment of the displaced su- pracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Or- thop 1991;11:705-711.
20. Aktekin CN, Toprak A, Ozturk AM, et al. Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures. J Pediatr Orthop B 2008;17:171-178.
21. Kazımoğlu C, Cetin M, Şener M, et al. Operative manage- ment of type III extension supracondylar fractures in chil- dren. Int Orthop 2009;33:1089-1094.
22. Reitman RD, Waters P, Millis M. Open reduction and in- ternal fixation for supracondylar humerus fractures in chil- dren. J Pediatr Orthop 2001;21:157–161.
23. Oh CW, Park BC, Kim PT, et al. Completely displaced su- pracondylar humerus fractures in children: results of open reduction versus closed reduction. J Orthop Sci 2003;8:137- 141.
24. Pretell Mazzini J, Rodriguez Martin J, Andres Esteban EM. Surgical approaches for open reduction and pinning in se- verely displaced supracondylar humerus fractures in chil- dren: a systematic review. J Child Orthop 2010;143-152.
25. Sibly TF, Briggs PJ, Gibson MJ. Supracondylar fractures of the humerus in childhood: range of movement fol- lowing the posterior approach to open reduction. Injury 1991;22:456-458.
26. Eberl R, Eder C, Smolle E, et al. Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of su- pracondylar humeral fractures in children. Acta Orthop 2011;82:606-609.
27. Özcelik A, Tekcan A, Ömeroglu H. Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. J Pediatr Orthop B 2006;16:58–61.
28. Kalenderer O, Reisoglu A, Surer L, et al. How should one treat iatrogenic ulnar nerve injury after closed reduction and percutaneous pinning of paediaric supracondylar hu- meral fractures? Injury 2008;39:463–466.
29. Rose RE, Phillips W. Iatrogenic ulnar neuropathies post- pinning of displaced supracondylar humerus fractures in children. West Indian Med J 2002;51:17–20.
30. Grag S, Weller A, Larson AN, et al. Clinical characteristics of severe supracondylar humerus fractures in children. J Pe- diatr Orthop 2014;34:34-39.