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Dallas M Smuin, William L Hennrikus
BACKGROUND: The pucker sign, also called skin tenting, indicates significant displacement of the supracondylar fracture and can be a cause for alarm. The purpose of this study is to compare a cohort of patients with type III supracondylar fractures presenting with a pucker sign to a group without a pucker sign by evaluating neurovascular injury at presentation, need for open reduction, persistent neurovascular injury, range of motion, and carrying angle at final follow-up. METHODS: A retrospective review was performed for Gartland type III extension type supracondylar fractures...
October 21, 2016: Journal of Pediatric Orthopedics
Justin Ernat, Christine Ho, Robert L Wimberly, ChanHee Jo, Anthony I Riccio
BACKGROUND: Few studies have prospectively assessed functional outcomes after the surgical management of supracondylar humerus fractures (SCHFXs) and the relationship between fracture pattern and ultimate patient outcome has never been prospectively evaluated. The purpose of this study was to prospectively evaluate fracture classification and functional outcome in children with extension SCHFXs using validated outcome measures. METHODS: An Institutional Review Board-approved prospective enrollment of consecutive patients with operative SCHFX was performed over a 3-year period...
October 21, 2016: Journal of Pediatric Orthopedics
Noora Tuomilehto, Reetta Kivisaari, Antti Sommarhem, Aarno Y Nietosvaara
Background and purpose - The quality of pin fixation of displaced supracondylar humerus fractures in children has not been assessed, and the clinical value of radiographic examinations after pin fixation is unclear. We evaluated pin configuration, quality of osteosynthesis, and outcome in 264 supracondylar fractures. The clinical significance of postoperative radiographs was analyzed. Patients and methods - 252 Gartland-III and 12 flexion-type supracondylar humerus fractures were pin-fixed in the periods 2002-2006 and 2012-2014...
October 24, 2016: Acta Orthopaedica
Nikolai Briffa, Raju Karthickeyan, Joshua Jacob, Arshad Khaleel
The aim of this study was to compare the biomechanical properties of medial and lateral plating of a medially comminuted supracondylar femoral fracture. A supracondylar femoral fracture model comparing two fixation methods was tested cyclically in axial loading. One-centimetre supracondylar gap osteotomies were created in six synthetic femurs approximately 6 cm proximal to the knee joint. There were two constructs investigated: group 1 and group 2 were stabilized with an 8-hole LC-DCP, medially and laterally, respectively...
October 12, 2016: Strategies in Trauma and Limb Reconstruction
Jorge Delgado, Diego Jaramillo, Nancy A Chauvin
Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Chun-Jui Weng, Chi-Chuan Wu, Kuo-Fun Feng, I-Chuan Tseng, Po-Cheng Lee, Yu-Chih Huang
BACKGROUND: Treatment of supraintercondylar (AO/OTA 33-C) and supracondylar (AO/OTA 33-A) femur fractures is generally challenging. Standard treatments include open reduction and internal fixation. However, optimal implants are now being well-defined. This study focus on the comparison between clinical and functional outcomes of fractures treated with condylar buttress plates (CBPs). METHODS: We treated 87 patients with supraintercondylar or supracondylar femur fracture from 2004 to 2008, including 30 supraintercondylar and 24 supracondylar fractures treated with CBPs...
October 4, 2016: BMC Musculoskeletal Disorders
Gurpal S Pannu, Craig P Eberson, Joshua M Abzug, Bernard D Horn, Donald S Bae, Martin Herman
Supracondylar humerus fractures and lateral condyle fractures are the two most common pediatric elbow fractures that require surgical intervention. Although most surgeons are familiar with supracondylar humerus fractures and lateral condyle fractures, these injuries present challenges that may lead to common errors in evaluation and management and, thus, compromise outcomes. It is well agreed upon that nondisplaced supracondylar fractures (Gartland type I) are best managed nonsurgically with cast immobilization...
February 15, 2016: Instructional Course Lectures
Joshua M Abzug, Christine Ann Ho, Todd F Ritzman, Brian Brighton
Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed...
February 15, 2016: Instructional Course Lectures
Daniel Bouton, Christine Ann Ho, Joshua M Abzug, Brian Brighton, Todd F Ritzman
Although flexion-type supracondylar humerus fractures account for a minority of all supracondylar humerus fractures, they warrant special attention because of their relatively high rate of requirement for open reduction and their potential for ulnar nerve injury or entrapment. The severity of flexion-type supracondylar humerus fractures may be difficult to appreciate on initial radiographs; therefore, surgeons must have a high index of suspicion in the evaluation of a patient who has a suspected flexion-type supracondylar humerus fracture...
February 15, 2016: Instructional Course Lectures
Jessica Jane Wingfield, Christine Ann Ho, Joshua M Abzug, Todd F Ritzman, Brian Brighton
Supracondylar humerus fractures are the most common elbow fractures in children. Displaced supracondylar humerus fractures that are associated with neurologic and/or vascular injuries should be treated with timely reduction via closed techniques. If closed reduction fails, reduction via open techniques is indicated. There is controversy about which surgical approach yields the best cosmetic and functional outcomes while minimizing postoperative complications. Open reduction, if indicated, has been reported to yield good outcomes in patients in whom closed reduction fails...
February 15, 2016: Instructional Course Lectures
Brian Brighton, Joshua M Abzug, Christine Ann Ho, Todd F Ritzman
Pediatric supracondylar humerus fractures are the most commonly encountered type of elbow fractures in children that require surgical fixation. Many pediatric supracondylar humerus fractures can be treated with closed reduction and percutaneous skeletal fixation. In difficult fractures, adjunct pin techniques, such as joystick wires and leverage pins, can be used to help attain a satisfactory and stable reduction before an open approach is used. After the fracture is reduced, optimal pinning, with the use of either crossed or lateral-entry techniques, and fixation that achieves maximal spread at the fracture site as well as bicortical engagement in both fragments are essential to maintain reduction and avoid complications that are associated with malunion...
February 15, 2016: Instructional Course Lectures
M Burnier, G Buisson, A Ricard, V Cunin, J P Pracros, F Chotel
INTRODUCTION: Among the various elbow injuries in children that initially have normal radiographs, a certain number of occult fractures are only diagnosed correctly after the fact, during a follow-up visit. PURPOSE: This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography. MATERIALS AND METHODS: During this prospective study performed between January 1 and April 1 2014, elbow ultrasonography was performed within 6 days in all children under 15 years of age with a suspected occult fracture...
September 30, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
J-J Sinikumpu, S Victorzon, T Pokka, E-L Lindholm, T Peljo, W Serlo
AIMS: We present the clinical and radiographic outcome of 81 children with Gartland type I to III supracondylar humeral fractures at a minimum follow-up of ten years (mean 12.1 years; 10.3 to 16.1) following injury. PATIENTS AND METHODS: The clinical and functional outcomes are compared with normal age- and gender-matched individuals. The population-based study setting was first identified from the institutional registries; the rate of participation was 76%. Controls were randomly selected from Finnish National Population Registry...
October 2016: Bone & Joint Journal
Nicholas F Matlovich, Brent A Lanting, Edward M Vasarhelyi, Douglas D Naudie, Richard W McCalden, James L Howard
BACKGROUND: Fracture location is an important consideration in managing supracondylar periprosthetic femur fractures. The outcomes of locked plating and intramedullary (IM) nail fixation were therefore compared based on fracture location, being above or at/below the total knee arthroplasty (TKA) flange. METHODS: Fifty-seven patients were identified from surgical records as being treated for supracondylar periprosthetic femur fracture with either a locking plate (n = 38) or IM nail (n = 19)...
August 3, 2016: Journal of Arthroplasty
Lauren Roberts, Jason Strelzow, Emily K Schaeffer, Christopher W Reilly, Kishore Mulpuri
BACKGROUND: Although the recommended treatment for Gartland types I and III supracondylar humeral fractures is well-established, the optimal treatment for type II fractures without rotational malalignment remains controversial, involving circumferential casting or closed reduction and pinning. Our institution uses pronated flexion-taping for Gartland type IIA fractures. This theoretically removes external pressure secondary to circumferential casting, potentially decreasing risks of compartment syndrome and mitigating loss of reduction with extension while maintaining optimal flexion position for reduction...
September 15, 2016: Journal of Pediatric Orthopedics
Phani Chakravarty Mutnuru, Lakshmi Manasa Perubhotla
Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora's lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas.
July 2016: Journal of Clinical and Diagnostic Research: JCDR
Sinisa Dučić, Vladimir Radlović, Bojan Bukva, Zoran Radojičić, Goran Vrgoč, Iva Brkić, Tatjana Jaramaz Dučić, Hari Jurdana, Dusan Abramović, Nikola Bojović, Lovro Štefan
BACKGROUND: Closed reduction and percutaneous pinning are the preferred treatment of displaced supracondylar humeral fractures in children. The purpose of this study is to evaluate the non-standard Dorgan's method and compare its results with those of the standard percutaneous cross pinning method in treatment of unstable or irreducible Gartland type II and III supracondylar humeral fractures in children. PATIENTS AND METHODS: This was a prospective evaluation of 138 consecutive patients with Gartland type II or III extension supracondylar humeral fractures referred to University Children's Hospital during a four-year period...
September 7, 2016: Injury
Christine A Ho, David A Podeszwa, Anthony I Riccio, Robert L Wimberly, Brandon A Ramo
BACKGROUND: Neurovascular injury in pediatric supracondylar fractures (SCHFx) has been associated with fracture classification but not with soft tissue injury. The purpose of this study is to correlate clinical soft tissue damage to neurovascular injuries in SCHFx. METHODS: This is an institutional review board approved prospective study from January 2010 through December 2013 of 748 operatively treated pediatric SCHFx. Prospective data were gathered both preoperatively and intraoperatively regarding detailed neurovascular examination as well as soft tissue status, with qualitative descriptives for swelling (mild/moderate/severe), ecchymosis, abrasions, skin tenting, and skin puckering...
September 3, 2016: Journal of Pediatric Orthopedics
Ersin Erçin, Mustafa Gökhan Bilgili, Emre Baca, Serdar Hakan Başaran, Alkan Bayrak, Cemal Kural, Mustafa Cevdet Avkan
BACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury. METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously...
July 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
A E Dekker, P Krijnen, I B Schipper
PURPOSE: Supracondylar humeral fractures (SCHF) are among the most common injuries in children. The aim of this systematic review was to investigate functional and radiographic outcome after crossed and lateral K-wire fixation for displaced extension-type SCHF, and complications related to the type of K-wire construction used. METHODS: RCTs and prospective comparative cohorts on the functional outcome and complications after fracture reduction and K-wire fixation were identified in MEDLINE, Embase, Web of Science and the Cochrane Library...
August 29, 2016: Injury
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