Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning.

Sir,

I read with interest the article by Sharma et al.1 titled as “Early results of displaced supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning.” The authors have introduced the novel lateral trans-olecranon pinning technique for displaced supracondylar fracture of the humerus which is quiet appreciable. I would like to discuss some issues related to this article.

Although in both lateral pinning technique and lateral trans-olecranon pin groups, satisfactory results were obtained in 90% cases. In lateral trans-olecranon pinning technique, the elbow is fixed in 90° of flexion which might not be feasible in massive swelling of the elbow, impending compartment syndrome and pulseless hand. It must be emphasized that flexion of the elbow of 90° or more with a type III supracondylar fracture significantly increases the risk of compartment syndrome and should rarely, if ever, be done if modern operative facilities and an experienced surgeon are available.2

The author has not mentioned the type of fixation used in the patients who had the massive swelling of the elbow and the patients with a feeble radial pulse with adequate perfusion. Even if a distal pulse is found by palpation or Doppler examination, an evolving compartment syndrome may be present.3

Although open fractures, Gustilo–Anderson grade II and III, an irreducible fracture or fracture with vascular injury having a pulseless arm with poor perfusion were excluded from the study. The author has not mentioned such type of fractures as a possible limitation to lateral-trans-olecranon pinning technique.

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