Author's reply.

Sir,

We thank Dr. Mehraj Din Tantray1 for showing a keen interest in our article titled as “Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning.2]"

We agree with Dr. Tantray on the fact 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 be done. Rather the authors also refrain from giving flexion of 90° or more at the elbow after fixing a supracondylar fracture with either the transolecranon or the lateral pinning technique in patients with massive swelling and this does not cause any difficulty in insertion of the transolecranon wire. Thus, the lateral-transolecranon technique can be used in Grade III supracondylar fractures with massive swelling.

In fact, in the transolecranon technique, the lateral entry wire was first inserted so that once the fracture was somewhat stabilized, the elbow may be extended to beyond 90° and then the transolecranon wire was inserted. Had the transolecranon K-wire been inserted before the lateral entry wire, the former would not have allowed much extension at the elbow.

A key point to remember in the transolecranon technique is that after inserting the lateral entry K-wire in full flexion, the elbow is extended to beyond 90° and the transolecranon wire inserted. However, once the transolecranon wire has been inserted, the elbow should be maintained in the same position of flexion, even while applying the plaster of paris splint. Otherwise, movement of the elbow can cause bending or even breakage of this K-wire.

We excluded open fractures, Gustilo–Anderson grade II and III, an irreducible fracture or fracture with vascular injury having a pulseless arm with poor perfusion from the study as an open reduction is mandatory in such cases with vascular repair. However, the study was undertaken for closed treatment of supracondylar fractures in children. This does not conclude that the aforementioned cases are a possible limitation to a lateral transolecranon pinning technique which can very well be utilized like any other technique for open reduction and internal fixation.