Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Hailong ^1,2 , LIU Fang ² , ZHOU Zhilin ² , ZHANG Sicheng ² , HUA Zhongtuo ² , JIA Guoqiang ² ,  SUN Jun ²

1. The Fifth Clinical College of Anhui Medical University, Hefei Anhui, 230000, P. R. China;
2. 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：

Humeral supracondylar fracture; multi-directional unstable fracture; closed reduction; internal fixation; child

DOI：

10.7507/1002-1892.202307015

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Objective To investigate the effectiveness of medial and lateral column periosteal hinge reconstruction using Kirschner wire in the closed reduction of multi-directional unstable humeral supracondylar fractures in children. Methods A clinical data of 43 children with multi-direction unstable humeral supracondylar fractures, who met the selection criteria and were admitted between August 2020 and August 2022, was retrospectively analyzed. Twenty-one cases of fractures were treated wuth closed reduction after medial and lateral column periosteal hinge reconstruction using Kirschner wire and percutaneous Kirschner wires fixation (study group), while 22 cases of fractures were treated by traditional closed reduction technique and percutaneous Kirschner wire fixation (control group). There was no significant difference in gender, age, cause of injury, fracture side, and interval from injury to operation between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, the number of children who were changed to open reduction after closed reduction failure, fracture healing time, complications within 2 months after operation, and the Flynn score of elbow joint function at last follow-up were compared between the two groups. Results All the fractures in the study group were successfully closed reduction, and 4 cases in the control group were changed to open reduction and completed the operation, the difference between the two groups was significant (P=0.040). The operation time and intraoperative fluoroscopy times of the study group were significantly less than those of the control group (P<0.05). All children in both groups were followed up 6-18 months with an average of 9.0 months in the study group and 9.8 months in the control group. Imaging review showed that the fractures of both groups healed, and the difference in the healing time between the two groups was not significant (P=0.373). According to Flynn score at last follow-up, the excellent and good rate of elbow joint function was 95.2% (20/21) in the study group and 86.4% (19/22) in the control group, with no significant difference (P=0.317). There was no complication such as infection or irritation at the end of Kirchner wire within 2 months after operation. Conclusion For children with multi-directional unstable humeral supracondylar fractures, the use of Kirschner wires to reconstruct the medial and lateral column periosteal hinge to assist in closed reduction has the advantages of shortening operation time, reducing intraoperative fluoroscopy times, and effectively reducing the incidence of open reduction, and can achieve similar postoperative elbow joint function when compared with traditional closed reduction technique.

Citation： MA Hailong, LIU Fang, ZHOU Zhilin, ZHANG Sicheng, HUA Zhongtuo, JIA Guoqiang, SUN Jun. Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1220-1224. doi: 10.7507/1002-1892.202307015 Copy

1.	Pavone V, Vescio A, Accadbled F, et al. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop, 2022, 16(3): 208-219.
2.	Radaideh AM, Rusan M, Obeidat O, et al. Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture: A retrospective cohort study. World J Orthop, 2022, 13(3): 250-258.
3.	熊子轩, 赵胡日查, 祁凯, 等. 儿童多方向不稳定肱骨髁上骨折操纵杆辅助闭合复位技术的研究进展. 临床小儿外科杂志, 2023, 22(6): 593-596.
4.	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.
5.	Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
6.	Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
7.	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.
8.	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.
9.	孙亮, 刘万林, 韦宜山, 等. 半无菌技术在闭合复位经皮克氏针内固定治疗儿童肱骨髁上骨折中的应用. 中华小儿外科杂志, 2019, 40(6): 536-539.
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.	Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
12.	Georgescu I, Gavriliu S, Pârvan A, et al. Burnei’s “double X” internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions: Study and Research Group in Pediatric Orthopaedics-2012. J Med Life, 2013, 6(2): 131-139.
13.	Lee HY, Kim SJ. Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique. J Bone Joint Surg (Br), 2007, 89(5): 646-650.
14.	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(4): 171-178.
15.	周志林, 马海龙, 孙军, 等. 拇指拨挡技术在儿童Gartland Ⅲ型肱骨髁上骨折尺侧穿克氏针中的应用. 中国修复重建外科杂志, 2023, 37(2): 142-146.

1. Pavone V, Vescio A, Accadbled F, et al. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop, 2022, 16(3): 208-219.
2. Radaideh AM, Rusan M, Obeidat O, et al. Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture: A retrospective cohort study. World J Orthop, 2022, 13(3): 250-258.
3. 熊子轩, 赵胡日查, 祁凯, 等. 儿童多方向不稳定肱骨髁上骨折操纵杆辅助闭合复位技术的研究进展. 临床小儿外科杂志, 2023, 22(6): 593-596.
4. 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.
5. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
6. Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
7. 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.
8. 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.
9. 孙亮, 刘万林, 韦宜山, 等. 半无菌技术在闭合复位经皮克氏针内固定治疗儿童肱骨髁上骨折中的应用. 中华小儿外科杂志, 2019, 40(6): 536-539.
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. Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
12. Georgescu I, Gavriliu S, Pârvan A, et al. Burnei’s “double X” internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions: Study and Research Group in Pediatric Orthopaedics-2012. J Med Life, 2013, 6(2): 131-139.
13. Lee HY, Kim SJ. Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique. J Bone Joint Surg (Br), 2007, 89(5): 646-650.
14. 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(4): 171-178.
15. 周志林, 马海龙, 孙军, 等. 拇指拨挡技术在儿童Gartland Ⅲ型肱骨髁上骨折尺侧穿克氏针中的应用. 中国修复重建外科杂志, 2023, 37(2): 142-146.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children

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