Application of thumb blocking technique with ulnar Kirschner wire threading for Gartland type Ⅲ supracondylar humerus fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Zhilin , MA Hailong ,  SUN Jun , YUAN Yi , ZHANG Sicheng , LIU Fang , HUA Zhongtuo , GUAN Zhiye

Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China;

Corresponding author：

SUN Jun, Email: sunjun500@aliyun.com

Keywords：

Supracondylar humerus fracture; thumb blocking technique; Kirschner wire; iatrogenic ulnar nerve injury; children

DOI：

10.7507/1002-1892.202210085

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Objective To explore the effectiveness of thumb blocking technique through closed reduction of ulnar Kirschner wire threading in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children. Methods The clinical data of 58 children with Gartland type Ⅲ supracondylar humerus fractures treated with closed reduction of ulnar Kirschner wire threading by thumb blocking technique between January 2020 and May 2021 were retrospectively analyzed. There were 31 males and 27 females with an average age of 6.4 years ranging from 2 to 14 years. The causes of injury were falling in 47 cases and sports injury in 11 cases. The time from injury to operation ranged from 24.4 to 70.6 hours, with an average of 49.6 hours. The twitch of ring and little fingers was observed during operation, the injury of ulnar nerve was observed after operation, and the healing time of fracture was recorded. At last follow-up, the effectiveness was evaluated by Flynn elbow score, and the complications were observed. Results There was no twitch of the ring and little fingers when the Kirschner wire was inserted on the ulnar side during operation, and the ulnar nerve was not injured. All children were followed up 6-24 months, with an average of 12.9 months. One child had postoperative infection in the operation area, local skin redness and swelling, and purulent secretion exudation at the eye of the Kirschner wire, which was improved after intravenous infusion and regular dressing change in the outpatient department, and the Kirschner wire was removed after the initial healing of the fracture; 2 children had irritation at the end of the Kirchner wire, and recovered after oral antibiotics and dressing change in the outpatient department. There was no serious complication such as nonunion and malunion, and the fracture healing time ranged from 4 to 6 weeks, with an average of 4.2 weeks. At last follow-up, the effectiveness was evaluated by Flynn elbow score, which was excellent in 52 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 96.6%. Conclusion The treatment of Gartland type Ⅲ supracondylar humerus fractures in children by closed reduction and ulnar Kirschner wire fixation assisted with thumb blocking technique is safe and stable, and will not cause iatrogenic ulnar nerve injury.

Citation： ZHOU Zhilin, MA Hailong, SUN Jun, YUAN Yi, ZHANG Sicheng, LIU Fang, HUA Zhongtuo, GUAN Zhiye. Application of thumb blocking technique with ulnar Kirschner wire threading for Gartland type Ⅲ supracondylar humerus fractures in children. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 142-146. doi: 10.7507/1002-1892.202210085 Copy

1.	Dineen HA, Stone J, Ostrum RF. Closed reduction percutaneous pinning of a pediatric supracondylar distal humerus fracture. J Orthop Trauma, 2019, 33 Suppl 1: S7-S8.
2.	Kropelnicki A, Ali AM, Popat R, et al. Paediatric supracondylar humerus fractures. Br J Hosp Med (Lond), 2019, 80(6): 312-316.
3.	Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
4.	Swenson AL. The treatment of supracondylar fractures of the humerus by kirschner-wire transfixion. J Bone Joint Surg (Am), 1948, 30A(4): 993-997.
5.	Segal D, Cobb L, Little KJ. Fracture obliquity is a predictor for loss of reduction in supracondylar humeral fractures in older children. J Pediatr Orthop B, 2020, 29(2): 105-116.
6.	Mitchell SL, Sullivan BT, Ho CA, et al. Pediatric Gartland type-Ⅳ supracondylar humeral fractures have substantial overlap with flexion-type fractures. J Bone Joint Surg (Am), 2019, 101(15): 1351-1356.
7.	Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin, 2006, 22(1): 69-75.
8.	Silva M, Cooper SD, Cha A. The outcome of surgical treatment of multidirectionally unstable (type Ⅳ) pediatric supracondylar humerus fractures. J Pediatr Orthop, 2015, 35(6): 600-605.
9.	马海龙, 管之也, 孙锡玮, 等. 克氏针重建骨膜铰链联合 “擀面杖” 技术治疗儿童屈曲桡偏型肱骨髁上骨折. 中华创伤杂志, 2022, 38(6): 545-550.
10.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
11.	Shannon FJ, Mohan P, Chacko J, et al. “Dorgan’s” percutaneous lateral cross-wiring of supracondylar fractures of the humerus in children. J Pediatr Orthop, 2004, 24(4): 376-379.
12.	Iobst CA, Bunhor D, Skaggs DL, et al. Intra-operative bone stability test. Tech Orthop, 2018, 33(4): 279-282.
13.	孙燕, 肖黎, 何东, 等. 闭合复位克氏针交叉固定治疗儿童屈曲型肱骨髁上骨折. 中华创伤骨科杂志, 2019, 21(1): 70-72.
14.	Green DW, Widmann RF, Frank JS, et al. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma, 2005, 19(3): 158-163.
15.	Michael SP, Stanislas MJ. Localization of the ulnar nerve during percutaneous wiring of supracondylar fractures in children. Injury, 1996, 27(5): 301-302.
16.	Woo CY, Ho HL, Ashik MBZ, et al. Paediatric supracondylar humeral fractures: a technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury. Singapore Med J, 2018, 59(2): 94-97.
17.	Okamoto M, Abe M, Shirai H, et al. Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography. J Hand Surg (Br), 2000, 25(1): 85-89.

1. Dineen HA, Stone J, Ostrum RF. Closed reduction percutaneous pinning of a pediatric supracondylar distal humerus fracture. J Orthop Trauma, 2019, 33 Suppl 1: S7-S8.
2. Kropelnicki A, Ali AM, Popat R, et al. Paediatric supracondylar humerus fractures. Br J Hosp Med (Lond), 2019, 80(6): 312-316.
3. Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
4. Swenson AL. The treatment of supracondylar fractures of the humerus by kirschner-wire transfixion. J Bone Joint Surg (Am), 1948, 30A(4): 993-997.
5. Segal D, Cobb L, Little KJ. Fracture obliquity is a predictor for loss of reduction in supracondylar humeral fractures in older children. J Pediatr Orthop B, 2020, 29(2): 105-116.
6. Mitchell SL, Sullivan BT, Ho CA, et al. Pediatric Gartland type-Ⅳ supracondylar humeral fractures have substantial overlap with flexion-type fractures. J Bone Joint Surg (Am), 2019, 101(15): 1351-1356.
7. Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin, 2006, 22(1): 69-75.
8. Silva M, Cooper SD, Cha A. The outcome of surgical treatment of multidirectionally unstable (type Ⅳ) pediatric supracondylar humerus fractures. J Pediatr Orthop, 2015, 35(6): 600-605.
9. 马海龙, 管之也, 孙锡玮, 等. 克氏针重建骨膜铰链联合 “擀面杖” 技术治疗儿童屈曲桡偏型肱骨髁上骨折. 中华创伤杂志, 2022, 38(6): 545-550.
10. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
11. Shannon FJ, Mohan P, Chacko J, et al. “Dorgan’s” percutaneous lateral cross-wiring of supracondylar fractures of the humerus in children. J Pediatr Orthop, 2004, 24(4): 376-379.
12. Iobst CA, Bunhor D, Skaggs DL, et al. Intra-operative bone stability test. Tech Orthop, 2018, 33(4): 279-282.
13. 孙燕, 肖黎, 何东, 等. 闭合复位克氏针交叉固定治疗儿童屈曲型肱骨髁上骨折. 中华创伤骨科杂志, 2019, 21(1): 70-72.
14. Green DW, Widmann RF, Frank JS, et al. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma, 2005, 19(3): 158-163.
15. Michael SP, Stanislas MJ. Localization of the ulnar nerve during percutaneous wiring of supracondylar fractures in children. Injury, 1996, 27(5): 301-302.
16. Woo CY, Ho HL, Ashik MBZ, et al. Paediatric supracondylar humeral fractures: a technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury. Singapore Med J, 2018, 59(2): 94-97.
17. Okamoto M, Abe M, Shirai H, et al. Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography. J Hand Surg (Br), 2000, 25(1): 85-89.

Chinese Journal of Reparative and Reconstructive Surgery

Application of thumb blocking technique with ulnar Kirschner wire threading for Gartland type Ⅲ supracondylar humerus fractures in children

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