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Indian Journal of Orthopaedics Surgery


Outcome of crossed pinning in supracondylar humerus fractures Gartland type III


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Author Details: Roshan SD, Ramu AC, Ranganatha N, Subrahmanya MP

Volume : 2

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 402

Article End Page : 406


Abstract

Background: Displaced supracondylar humerus fracture in children presents a severe degree of injury often associated with potential neurovascular complications. We conducted this study to assess the functional and radiological outcome and complications of supracondylar humerus fractures Gartland type III treated with closed manipulation and crossed pinning.
Methods: We analysed the clinical and radiographic data of 37 children with supracondylar humerus fracture Gartland type III which was collected retrospectively over a 3 year period (January 2013 – January 2016). The average follow-up period in all patients exceeded 1 year. Clinical evaluation included Flynn's criteria, pain, neurovascular examination, and complications (infection or iatrogenic nerve injuries). Humeroulnar angle was measured in the final follow-up radiograph.
Results: The average follow-up period was 22 months. The mean age of the children was 7.4 years. According to Flynn's criteria functional results were satisfactory in 100% and cosmetic results were satisfactory in 89.18% of patients. Outcome was graded as unsatisfactory in 4 (10.8%) patients due to loss of carrying angle. The average carrying angle was 9.40 while it was 11.20 on the contralateral side. At the final follow-up the average visual analogue scale (VAS) score was 0. Injury related complications included absent pulse in 3 (8.1%) and 1 (2.7%) primary median nerve palsy. Treatment related complications include 3 (8.1%) iatrogenic ulnar nerve palsy.
Conclusion: Closed manipulation and percutaneous crossed pinning of supracondylar humerus fracture Garland type III is an effective and minimally invasive method. Crossed pinning provided biomechanically stable fixation but with an increased risk of ulnar nerve injury.

Keywords:
Supracondylar humerus fracture, Closed manipulation, Crossed pinning