J C Cheng1, T P Lam, W Y Shen. 1. Pediatric Orthopaedic Service Department of Orthopaedics & Traumatology The Chinese University of Hong-Kong, Prince of Wales Hospital, Shatin, N. T., Hong-Kong.
Abstract
GOAL OF SURGERY: Closed reduction of acute type III (according to Gartland) supracondylar extension fractures of the distal humerus and unicondylar pin fixation. INDICATIONS: Type III and unstable type II supracondylar fractures. CONTRAINDICATIONS: Swelling of the elbow. Compartment syndrome. PREOPERATIVE WORK UP: Radiographs of both elbows in the anterior-posterior and lateral projections. POSITIONING AND ANAESTHESIA: Supine with arm on arm board. General anaesthesia. SURGICAL TECHNIQUE: Closed reduction through manipulation under fluoroscopic control. Fixation with 2 Kirschner wires introduced percutaneously through the lateral condyle. Long arm cast for 4 to 5 weeks. POSTOPERATIVE MANAGEMENT: Radiographs on the first postoperative day, 1 week later and at time of cast and pin removal 4 to 5 weeks postoperatively. At that time active mobilisation of the elbow is started. Follow-up for 1 to 2 years is recommended. POSSIBLE COMPLICATIONS: Damage of ossific nucleus of physis. Damage to neurovascular structures. Wire migration. Pin tract infection. RESULTS: Out of 82 children (mean age 6.5 years) 73 had a follow-up of more than 6 months. 80.8% had good or excellent results. 15.1% had a decrease of the carrying angle of more than 10 degrees (4.1% more than 20 degrees ). There were 2 pin tract infections and 1 iatrogenic transient ulnar palsy.
GOAL OF SURGERY: Closed reduction of acute type III (according to Gartland) supracondylar extension fractures of the distal humerus and unicondylar pin fixation. INDICATIONS: Type III and unstable type II supracondylar fractures. CONTRAINDICATIONS: Swelling of the elbow. Compartment syndrome. PREOPERATIVE WORK UP: Radiographs of both elbows in the anterior-posterior and lateral projections. POSITIONING AND ANAESTHESIA: Supine with arm on arm board. General anaesthesia. SURGICAL TECHNIQUE: Closed reduction through manipulation under fluoroscopic control. Fixation with 2 Kirschner wires introduced percutaneously through the lateral condyle. Long arm cast for 4 to 5 weeks. POSTOPERATIVE MANAGEMENT: Radiographs on the first postoperative day, 1 week later and at time of cast and pin removal 4 to 5 weeks postoperatively. At that time active mobilisation of the elbow is started. Follow-up for 1 to 2 years is recommended. POSSIBLE COMPLICATIONS: Damage of ossific nucleus of physis. Damage to neurovascular structures. Wire migration. Pin tract infection. RESULTS: Out of 82 children (mean age 6.5 years) 73 had a follow-up of more than 6 months. 80.8% had good or excellent results. 15.1% had a decrease of the carrying angle of more than 10 degrees (4.1% more than 20 degrees ). There were 2 pin tract infections and 1 iatrogenic transient ulnar palsy.