Factors determining loss of reduction in paediatric supracondylar humerus fractures treated by closed reduction and percutaneous pinning.
Journal
Journal of pediatric orthopedics. Part B
ISSN: 1473-5865
Titre abrégé: J Pediatr Orthop B
Pays: United States
ID NLM: 9300904
Informations de publication
Date de publication:
01 May 2022
01 May 2022
Historique:
pubmed:
22
7
2021
medline:
5
4
2022
entrez:
21
7
2021
Statut:
ppublish
Résumé
Closed reduction and percutaneous pinning is the preferred surgical intervention for paediatric supracondylar humerus fractures (SCHF). Loss of reduction (LOR) is one of the infrequent complications associated with percutaneous pinning. We aim to analyse the various factors that could lead to LOR. We retrospectively reviewed records of all children with Gartland's type III and IV SCHF who were operated at our institution between 2014 and 2016. A defined set of radiologic indices were measured on postoperative and follow-up radiographs. Correlation between LOR (as defined by Skaggs) and radiologic indices, was calculated. In total 187 children who satisfied the inclusion criteria were included in the study. Major LOR was present in 8 patients (4.28%), mild LOR was seen in 21 patients (11.22%), and there was no LOR in 158 patients (84.49%). A pin-spread fracture width ratio of 0.37 had maximum sensitivity and specificity for predicting LOR. The convergent pin configuration had the highest rate of LOR of 15%, whereas it was about 3% in the crossed pin and lateral divergent pinning group. The incidence of iatrogenic ulnar nerve injury in our series was 4.76%, and all were in the cross pinning group. Pin-spread fracture width ratio is the most crucial factor determining LOR, and a ratio of less than 0.37 has a significantly higher rate of LOR. As the incidence of LOR is not significantly different between the lateral-only and crossed pin groups, a medial pin should be used judiciously to avert the risk of ulnar nerve injury. Level of evidence: Level IV.
Identifiants
pubmed: 34285159
doi: 10.1097/BPB.0000000000000899
pii: 01202412-202205000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
289-295Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop 2007; 27:181–186.
Khoshbin A, Leroux T, Wasserstein D, Wolfstadt J, Law PW, Mahomed N, et al. The epidemiology of paediatric supracondylar fracture fixation: a population-based study. Injury 2014; 45:701–708.
Skaggs DL, Flynn JM. Supracondylar fracture of the distal humerus. In: Rockwood and Wilkin’s Fractures in Children. 8th ed. Philadelphia, Pennsylvania: Wolters Kluwer; 2001. p. 581.
Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, et al.; American Academy of Orthopaedic Surgeons. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 2012; 20:320–327.
Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am 2001; 83:735–740.
Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1994; 76:253–256.
Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in supracondylar fracture of the humerus in children. J Orthop Trauma 2012; 26:48–53.
Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a Randomized Clinical Trial. J Bone Jt Surg-Am. 2007; 89:706–12.
Pennock AT, Charles M, Moor M, Bastrom TP, Newton PO. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop 2014; 34:691–697.
Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res 2015; 473:738–741.
Rang M, Pringer ME, Wenger RD. Rang’s Children’s Fractures. 3rd ed. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2005. p. 104.
AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma. 2018; 32:S117–40.
Shank CF, Wiater BP, Pace JL, Jinguji TM, Schmale GA, Bittner RC, et al. The lateral capitellohumeral angle in normal children: mean, variation, and reliability in comparison to Baumann’s angle. J Pediatr Orthop 2011; 31:266–271.
Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 2004; 86:702–707.
Balakumar B, Madhuri V. A retrospective analysis of loss of reduction in operated supracondylar humerus fractures. Indian J Orthop 2012; 46:690–697.
Mohammed R, Bhogadi P, Metikala S. A study of biplanar crossed pin construct in the management of displaced pediatric supracondylar humeral fractures. J Child Orthop 2014; 8:435–441.
Cramer KE, Green NE, Devito DP. Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. J Pediatr Orthop 1993; 13:502–505.