Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type <b>Ⅲ</b> supracondylar humerus fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DENG Yinshuan ¹ , BAI Jing ¹ ,  LIU Rui ¹ , DA Zhaoming ¹ , YAN Weishun ¹ , CHEN Zhen ¹ , LI Shuo ¹ , QU Tao ¹ , NIU Weimin ¹ , GUO Binbin ¹ , YANG Zhiyun ¹ , LI Guohai ² , NAN Guoxin ³

1. Department of Orthopedics, Gansu Maternal and Child Health Hospital (Gansu Provincial Central Hospital), Lanzhou Gansu, 730050, P. R. China;
2. Department of Orthopedics, Gansu Linxia Pukang Hospital, Linxia Gansu, 731100, P. R. China;
3. Department of Orthopedics, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, P. R. China;

Corresponding author：

DENG Yinshuan, Email: kefandeng@163.com; LIU Rui, Email: 393845759@qq.com

Keywords：

Supracondylar humerus fracture; transverse antecubital incision; internal fixtion; failed closed reduction; children

DOI：

10.7507/1002-1892.202211033

Video：

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Objective To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. Methods Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. Results All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up (P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up (P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up (P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. Conclusion The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

Citation： DENG Yinshuan, BAI Jing, LIU Rui, DA Zhaoming, YAN Weishun, CHEN Zhen, LI Shuo, QU Tao, NIU Weimin, GUO Binbin, YANG Zhiyun, LI Guohai, NAN Guoxin. Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 566-571. doi: 10.7507/1002-1892.202211033 Copy

1.	Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop, 1998, 18(1): 38-42.
2.	Shenoy PM, Islam A, Puri R. Current management of paediatric supracondylar fractures of the humerus. Cureus, 2020, 12(5): e8137. doi: 10.7759/cureus.8137.
3.	Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop, 2010, 30(3): 253-263.
4.	Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr, 2014, 26(1): 64-69.
5.	Das R, Borthakur B, Agarwala V, et al. Evaluation of anterior approach in failed closed reduction and delayed presentation of supracondylar humerus fractures in children. J Orthop, 2022, 30(3): 51-58.
6.	Ay S, Akinci M, Kamiloglu S, et al. Open reduction of displaced pediatric supracondylar humeral fractures through the anterior cubital approach. J Pediatr Orthop, 2005, 25(2): 149-153.
7.	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.
8.	Pierz KA. Fractures in children and adolescents: distal humerus supracondylar fractures. J Chromesthesia, 2009, 24(3): 172-183.
9.	Mulhall KJ, Abuzakuk T, Curtin W, et al. Displaced supracondylar fractures of the humerus in children. Int Orthop, 2000, 24(4): 221-223.
10.	Ersan O, Gonen E, Arik A, et al. Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method. Int Orthop, 2009, 33(5): 1371-1375.
11.	Su Y, Nan G. Evaluation of a better approach for open reduction of severe Gartland type III supracondylar humeral fracture. J Invest Surg, 2021, 34(5): 479-485.
12.	Abraham E, Powers T, Witt P, et al. Experimental hyperextension supracondylar fractures in monkeys. Clin Orthop Relat Res, 1982, (171): 309-318.
13.	Suh SW, Oh CW, Shingade VU, et al. Minimally invasive surgical techniques for irreducible supracondylar fractures of the humerus in children. Acta Orthop, 2005, 76(6): 862-866.
14.	Koudstaal MJ, De Ridder VA, De Lange S, et al. Pediatric supracondylar humerus fractures: the anterior approach. J Orthop Trauma, 2002, 16(6): 409-412.
15.	Lee SS, Mahar AT, Miesen D, et al. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002, 22(4): 440-443.
16.	Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop, 2012, 32(4): 346-351.
17.	Sarrafan N, Nasab SA, Ghalami T. Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach: an investigation of clinical and radiographical results. Pak J Med Sci, 2015, 31(4): 930-935.

1. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop, 1998, 18(1): 38-42.
2. Shenoy PM, Islam A, Puri R. Current management of paediatric supracondylar fractures of the humerus. Cureus, 2020, 12(5): e8137. doi: 10.7759/cureus.8137.
3. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop, 2010, 30(3): 253-263.
4. Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr, 2014, 26(1): 64-69.
5. Das R, Borthakur B, Agarwala V, et al. Evaluation of anterior approach in failed closed reduction and delayed presentation of supracondylar humerus fractures in children. J Orthop, 2022, 30(3): 51-58.
6. Ay S, Akinci M, Kamiloglu S, et al. Open reduction of displaced pediatric supracondylar humeral fractures through the anterior cubital approach. J Pediatr Orthop, 2005, 25(2): 149-153.
7. 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.
8. Pierz KA. Fractures in children and adolescents: distal humerus supracondylar fractures. J Chromesthesia, 2009, 24(3): 172-183.
9. Mulhall KJ, Abuzakuk T, Curtin W, et al. Displaced supracondylar fractures of the humerus in children. Int Orthop, 2000, 24(4): 221-223.
10. Ersan O, Gonen E, Arik A, et al. Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method. Int Orthop, 2009, 33(5): 1371-1375.
11. Su Y, Nan G. Evaluation of a better approach for open reduction of severe Gartland type III supracondylar humeral fracture. J Invest Surg, 2021, 34(5): 479-485.
12. Abraham E, Powers T, Witt P, et al. Experimental hyperextension supracondylar fractures in monkeys. Clin Orthop Relat Res, 1982, (171): 309-318.
13. Suh SW, Oh CW, Shingade VU, et al. Minimally invasive surgical techniques for irreducible supracondylar fractures of the humerus in children. Acta Orthop, 2005, 76(6): 862-866.
14. Koudstaal MJ, De Ridder VA, De Lange S, et al. Pediatric supracondylar humerus fractures: the anterior approach. J Orthop Trauma, 2002, 16(6): 409-412.
15. Lee SS, Mahar AT, Miesen D, et al. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002, 22(4): 440-443.
16. Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop, 2012, 32(4): 346-351.
17. Sarrafan N, Nasab SA, Ghalami T. Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach: an investigation of clinical and radiographical results. Pak J Med Sci, 2015, 31(4): 930-935.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children

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