Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Mithun, E R (2011) Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Supracondylar fracture of humerus is the most common fracture in the children and needs proper management. This fracture is common in the first decade of life due to various causes mainly ligament laxity and anatomical structure of humerus tube(shaft) to flat transformation at lower end of humerus. Its incidence decreases with age. Its incidence is about 75% of fractures around elbow in children. Boys have a higher incidence than the girls. Common in left side or non dominant side. There are two types of supracondylar fractures) i) Extension type -- 97%, ii) Flexion type -- 3%. Mechanism of injury in extension type is fall on the out stretched hand with hyper extension at the elbow with abduction or adduction, with dorsiflexed hand. Flexion type occurs as a result of direct blow to elbow from behind. Supracondylar fractures of humerus need to be handled carefully to avoid drastic short term complications and vexing long term complications. The complications can be prevented by early and proper intervention. This can be achieved by proper anatomical reduction and maintenance of reduction either by percutaneous pinning or ORIF. AIM OF THE STUDY: The aim of the study is to “ Compare the functional and cosmetic outcome of supra condylar fractures of humerus in children treated by percutaneous pinning and ORIF with Kirschner Wires” at the Department of Orthopaedics & Traumatology, Government Royapettah Hospital/Government Kilpauk Medical College, between June 2008 and October 2010. MATERIALS AND METHODS: In this series of prospective study, 20 cases of supracondylar fractures Type II and Type III were managed out of which 10 cases were treated by Open Reduction and Internal Fixation, and the other 10 cases were treated by Percutaneous pinning. The study was carried out from June 2008 to October 2010, at the Department of Orthopaedic Surgery and Traumatology, Government Royapettah Hospital, Chennai. The cases were included in the study, depending on the following inclusion and exclusion criterias. Inclusion criteria: i) GARTLAND’S type II and III. ii) Patient less than 12 years. iii) Closed supracondylar fractures. Exclusion criteria : i) GARTLAND’S type I. ii) Open supracondylar fractures. iii) Patients with nerve injury. iv) Fractures with compartmental syndrome. v) Fractures needing vascular repair All the patients were planned for surgery immediately, since early intervention gives better results. But there were some restrictions. RESULTS: All the relevant data were analysed. The fracture was more in the age group of 5 – 8 yrs. Peak incidence for the supracondylar fractures of humerus is 6.7 yrs. Boys had higher incidence compared to the girls in the ratio of 65:35. This incidence was similar to that study conducted by Celiker et al(28). Though the mechanism of injury is fall on outstretched hand, the common mode of injury was fall from height like wall, trees, etc. Left upper limb or the non dominant side was more involved than the right or dominant side. About 60% of patients were operated within 24 hours of injury and the rest were operated later. Extension types were 19 patients(95%) of our study and only one patient (5%) was of flexion type. This inference correlates wih the study by Cekanauskas et al(29). Of the extension type, 15 patients (75%) were of type III and 4 patients (20%) were of Type II. About 80% of the patients who were treated by percutaneous pinning were discharged within 7 days, but only 30% of the patients who were treated by ORIF were discharged within the same period. In about 70 % of the patients treated by percutaneous pinning, fracture united in 3 weeks and in only 20% of the patients treated by ORIF did so in the same time. 30% of the patients from the both groups had union in 4 weeks. 50% of the patients treated by ORIF had union by the 6th week. All the patients were graded as per the FLYNN CRITERIA. In our study, all the patients treated by both means either ORIF or percutaneous pinning had an excellent result. CONCLUSION: Though both the procedures either ORIF or percutaneous pinning, gave excellent results functionally, we conclude that percutaneous pinning is the better option for supracondylar fractures of humerus for the following reasons 1) The cosmetic results was better, 2) Cost effective, 3) Stay in hospital was less, 4) Complications are less, 5) Union was earlier.

Item Type: Thesis (Masters)
Uncontrolled Keywords: functional and cosmetic outcome of supracondylar fractures ; children treatement ; percutaneous pinning ; open reduction and internal fixation ; K-wires.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:33
Last Modified: 17 Sep 2017 17:32
URI: http://repository-tnmgrmu.ac.in/id/eprint/2987

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