Search Results (8)

Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of complicated supracondylar humeral fractures (Gartland types II and III). Gartland type II and III fractures are most frequently treated with closed reduction and percutaneous Kirchner-wire pinning or open reduction with K-wire pinning, depending on the degree of displacement and the orthopedic surgeon’s preference. Most studies recommend avoiding open reduction because of prolonged hospitalization and higher rates of complications. Orthopedic surgeons have different opinions regarding the Kirschner pin placement technique. Studies suggest that only lateral pinning is safe and effective, but medial and lateral pinning is proven to give more stability; there is always a risk of iatrogenic ulnar nerve damage during surgery. Modern treatment of supracondylar humeral fracture in children should focus on minimally invasive techniques and avoid open reduction, when possible, to ensure the best outcome for the patients. This scoping review’s purpose is to gather the available information on the topic in one place and to underline the lack of clear protocols. Full article

Background: Gartland type III pediatric supracondylar humerus fractures can be unstable and prone to loss of reduction. The Internal Rotational Stress Test (IRST) aims to assess and address rotational instability during surgery. Method: This retrospective study analyzed treatments for Gartland type III pediatric supracondylar humerus fractures at our institution from January 2020 to December 2022. Only patients who underwent IRST were included. IRST was performed after inserting either two or three lateral pins. Patients were divided into Group 1 (IRST +) or 2 (IRST −) based on IRST results. Radiographic and clinical outcomes were compared between the two groups. Result: A total of 46 patients were included in the study. The mean age at the time of diagnosis was 5.7 years (range, 4 to 11 years), and the mean duration of follow-up was 2.8 years (range, 1.0 to 4.8 years). Group 1 consisted of 24 patients, and Group 2 comprised 22 patients. We did not find any differences in radiographic parameters and clinical scores between the two groups. Additionally, in both groups, there were no instances of major loss of reduction, defined as greater than 12 degrees or 12%. In five patients, we identified two types of fracture patterns that were stable with only two lateral pins. Conclusions: In patients with Gartland type III supracondylar humerus fractures, if reduction is adequately achieved and sufficient fixation force is maintained, the IRST results do not significantly impact radiologic and clinical outcomes. The pattern of the fracture can influence instability, necessitating further research on this matter. Full article

Background and Clinical Significance: Neurological complications in extension-type-III supracondylar humeral fractures (SCHFs) in children represent 11% of cases. An extension-type-III SCHF with posterolateral displacement of the distal fragment is commonly associated with damage to the median nerve and the anterior interosseous nerve (AIN). Neurological complications are often unnoticed, and their immediate postoperative diagnosis is difficult, particularly in young children. Neurapraxia, the most common complication, usually undergoes spontaneous nerve recovery. Case Presentation: We report a case of a 7-year-old patient with postoperative median nerve palsy after an SCHF (Gartland type III) who was referred to our unit from another hospital due to a lack of spontaneous recovery. In addition, motor and sensory functions were absent. As ultrasound (US) indicated nerve kinking at the fracture site, an exploration was performed. The nerve was trapped within the fracture and the callus. It was surgically extracted, and intraoperative examination with US indicated that resecting the kinked nerve, freeing the two stumps, and attempting a primary end-to-end suture represented the best course of action. We present this case with a 5-year follow-up surgery, which showed a good clinical outcome. Conclusions: This case is noteworthy because of its diagnostic and therapeutic pathways, and it is complemented by surgical and ultrasound images that can assist other surgeons in similar circumstances. Full article

Background/Objectives: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. Methods: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann’s angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with p < 0.05 considered significant. Results: No significant differences were observed in BA (p = 0.84) or SCA (p = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (p = 0.92) or radiation exposure (p = 0.12). The complication rate was 6.45%. Conclusions: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term. Full article

Supracondylar fractures of the humerus are frequent paediatric injuries. The aims of this study were to evaluate the applicability and reproducibility of the Gartland and Wilkins classification, the Baumann angle (BA) and the Anterior Humeral Line (AHL). This retrospective monocentric observational study was conducted on 217 patients. Four observers assessed the pre-operative radiographs by applying the Gartland and Wilkins classification and the post-operative X-rays by measuring the BA and AHL. The kappa coefficient (K) and the Cohen’s kappa were used for the reliability of the Gartland classification; the Intraclass Correlation Coefficient (ICC) for that of the BA. The AHL was evaluated in a double manner by using first the K and the Cohen’s kappa and then the ICC. A total of 186 patients were eligible. Inter-observer reliability for the Gartland classification was K = 0.73–0.61 for type III, 0.65–0.61 for type Ia and 0.43–0.26 for type IIb. The Baumann angle mean value in the first data collection was 73.5 ± 6.85 (inter-observer ICC 0.74) and 72.9 ± 6.83 (inter-observer ICC 0.77) for the second data collection; AHL: inter-observer ICC 0.87 for the first evaluation and 0.80 for the second one. Gartland’s classification modified by Wilkins has a high degree of reliability. BA and AHL appear reproducible and reliable. Full article

Background: Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children’s health and society as a whole. The main objective of this study was to determine whether obesity has an effect on the severity of supracondylar humerus fracture in children, regardless of whether it is a low- or high-energy trauma. Methods: The electronic records of patients treated for the supracondylar fracture of the humerus in the ten-year period from 1 January 2013 to 1 January 2023 were reviewed retrospectively. Results: In the observed period, 618 children, including 365 (59.06%) boys and 253 (40.94%) girls, were hospitalized and treated surgically with the diagnosis of supracondylar fracture. The distributions according to the observed parameters were as follows: age (months) = 88.18 ± 32.64; height (cm) = 123.42 ± 16.83; weight (kg) = 27.18 ± 11.32; body mass index = 17.18 ± 3.06; body mass index-for-age percentile = 57.34 ± 32.11. Overall, 141 (22.82%) fractures were classified as Gartland II, while 477 (77.18%) were classified as Gartland III. A total of 66 (10.68%) fractures were flexion type, while 552 (89.32%) were extension type. The left elbow was affected in 401 (64.89%) children, while the right was affected in 217 (35.11%) children. The main mechanism of injury was a fall at ground level (33.33%). In relation to gender, a statistically significant difference was recorded in body mass index and percentile (p < 0.05). According to Gartland, the proportion of children below and above the 85th percentile in relation to the type of injury was statistically significant (p < 0.05). It was determined that the energy level does not significantly influence the injury’s severity: p(GII) = 0.225; p(GIII) = 0.180. Conclusions: In our study, we found that the proportion of overweight and obese children requiring surgical treatment was higher in Gartland type III injury, so there is no doubt that as a society we must prevent further increases in the prevalence of childhood obesity for this reason as well. Full article

Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present. Full article

(1) Background: This study aims to describe the clinical and paraclinical characteristics of and the diagnostic approach to brachial artery injuries in pediatric supracondylar humerus fractures, as well as to evaluate intraoperative vascular anatomical lesions and early postoperative results. (2) Methods: A retrospective, hospital-based analysis of medical records at Viet Duc University Hospital (Vietnam), using a sample of children under 16 years who met the diagnostic criteria for supracondylar humerus fractures with brachial artery injuries between January 2016 and December 2020, was performed. A total of 50 patients were included in the analysis. (3) Results: Out of 50 pediatric patients, 36 patients were male (72%) and the mean age was 5.85 years (range, 1.5–14 years). Before treatment, there were 46 patients with severely displaced fractures which were classified as Gartland type III (92%). Following casting, the percentage of those with severely displaced fractures was reduced significantly to 12%, while there were no patients with Gartland type III fractures after percutaneous pinning. Doppler sonography failed to assess vascular lesions at the fracture site before and after casting in most patients. Two-thirds of surgical cases had only vasospasm, without physical damage to the vessel wall or intravascular thrombosis. Preoperative Doppler spectrum analysis was not consistent with the severity of intraoperative brachial artery injury. Out of 24 patients with vasospasm, we performed vascular blockade using papaverin in 11 cases and intraoperative balloon angioplasty of the brachial artery using the Fogarty catheter in 13 cases. Brachial artery graft was performed with 12 patients who had anatomical damage to the vascular wall. A complication of embolism occurred in one patient immediately after surgery, and two patients had superficial infections. One month following surgery, 2 out of 36 patients had a temporary loss of sensation in the area of incision. (4) Conclusions: Most pediatric patients did not present with symptoms of critical limb ischemia similar to those associated with lower extremity vascular injuries. The diagnosis and treatment of pediatric supracondylar humerus fractures with vascular injury is difficult and time-consuming, especially in cases of transverse fractures. Full article