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PubMed1984

Displaced supracondylar fractures of the humerus in children treated by overhead olecranon traction.

A simple method is described of treating severely displaced, supracondylar fractures of the humerus in children, and the results are reviewed. Treatment involves the use of overhead traction via an olecranon screw and a traction clip. Of 12 children treated in this way, 11 had excellent results with preservation of the normal carrying angle, and no significant loss of movement in any plane. There were no complications of the treatment and no cases of cubitus varus.

Bone Screws↗
PubMed1985

Supracondylar fracture of the humerus in children: review of closed and open reduction leading to a proposal for treatment.

Of 70 supracondylar fractures of the humerus in children, 25 were treated by open reduction and internal fixation, 24 by closed manipulation and plaster and 21 by plaster-of-Paris only. Three of the fractures were operated on because of suspected vascular injury (with or without neurological symptoms), another seven because of instability and/or extreme swelling and 15 after unsatisfactory closed reduction. Traction was used in 3 of the 24 patients treated by closed methods and among the other 21, three fractures had to be manipulated twice. Three to six years after the injury, 6 of the 25 patients operated on had reduced flexion-extension and/or deformity exceeding 10 degrees. Five patients treated by closed reduction had reduced movements or deformity exceeding 10 degrees and three patients with originally undisplaced fractures had deformity exceeding 10 degrees. In this study the most severe fractures were selected for operation but, in spite of this, the results were better than for fractures treated by closed reduction and plaster. Based on this and previous studies, a plan suitable for most departments is suggested for the treatment of this fracture.

Adolescent↗
PubMed1985

Immediate radial nerve palsy complicating fracture of the shaft of the humerus: when is early exploration justified?

A series of 59 patients with immediate complete radial nerve palsy complicating a fracture of the shaft of the humerus was analysed. In 27 patients the radial nerve was explored and the fracture was fixed within 3 weeks of the accident. In 12 other patients exploration was performed after an average of 17 weeks. The remaining 20 patients showed signs of spontaneous recovery within 4 months and were managed conservatively. The mean follow-up time was 3 years. At exploration, laceration, interposition between the fragments or entrapment of the radial nerve in callus was found significantly (P less than 0.01) more often with longitudinal fractures of the distal third (46 per cent) than with transverse fractures of the middle third, in which 85 per cent of the explored cases showed the nerve to be no more than slightly bruised. Useful recovery was seen in 46 patients (78 per cent of the whole series).

Adolescent↗
PubMed1986

Supracondylar fractures of the humerus in adults.

Thirty consecutive supracondylar fractures of the humerus, treated by open reduction and internal fixation over a 4-year period from 1980 to 1984, are reviewed. We feel that anatomical reduction with rigid fixation allowing immediate postoperative movement gives the least morbidity and best results.

Adult↗
PubMed1988

Diagnosis of vascular injury in children with supracondylar fractures of the humerus.

Four children with suspected vascular injury after supracondylar fractures of the humerus are presented. A noninvasive technique has been used in the diagnosis of vascular injury. A simple non-invasive method using the Doppler equipment connected to a spectrum analyser may exclude the need for arteriography and surgical exploration.

Brachial Artery↗
PubMed1989

Treatment of displaced fractures of the proximal humerus: transcutaneous reduction and Hoffmann's external fixation.

Experience with transcutaneous reduction and external fixation of displaced fractures of the proximal humerus is presented in a series of 28 cases followed for 1 year or more. In 18 cases near-anatomical fracture reduction was obtained, while no improvement of fracture position was seen in two cases. Loosening of the pins was a major complication in five cases, all in patients with severe osteoporosis or head splitting fractures, where fracture reduction was unsatisfactory. The functional results were satisfactory, and the method is considered a useful alternative in the treatment of these difficult fractures.

Adult↗
PubMed1989

Ipsilateral supracondylar fracture of humerus and forearm bones in children.

A total of 34 children with ipsilateral supracondylar fractures of the humerus and forearm were studied over an 8-year period. Of these, 19 patients had fractures of the distal quarter of the forearm bones while eight patients had a distal radial epiphyseal injury. Five of the patients had undisplaced supracondylar fractures. One patient had an anterior supracondylar fracture. All forearm fractures were treated by closed reduction. Nine displaced supracondylar fractures which could not be reduced by closed manipulation were treated by olecranon pin traction in two cases and by percutaneous pinning in seven cases. Excellent or good results were found in 29 children after an average follow-up of 3.8 years.

Adolescent↗
PubMed1990

Closed percutaneous K-wire stabilization for displaced fractures of the surgical neck of the humerus.

We report a series of 22 displaced fractures of the proximal humerus treated by percutaneous Kirschner wire stabilization. Poor results (69 per cent) in the older age group of patients is a reflection of the severity of the fracture and the difficulties of closed reduction. Reduction in a poor position in this series has led to a poor range of movement. Good functional results can only be expected with a good reduction. Experience of migration with smooth K-wires has resulted in a strong recommendation for the use of threaded pins.

Adolescent↗
PubMed1991

Prevention of cubitus varus deformity in supracondylar fractures of the humerus.

Based on cadaveric experiments, peroperative observations and clinical study, an exact mechanism is described by which full pronation of the forearm prevents cubitus varus deformity in supracondylar fractures of the humerus. The significance of the position of the upper limb in relation to the chest is described, and it has been demonstrated that even the posterolaterally displaced supracondylar fractures are better reduced and maintained in pronation.

Adolescent↗
PubMed1991

Flexion supracondylar fractures of the humerus in children: treatment by manipulation and extension cast.

We have reviewed, at an average of 7 years, 14 children with flexion supracondylar fractures of the humerus. These fractures accounted for 6 per cent of the 288 displaced supracondylar fractures treated from 1981 to 1985. A total of 12 patients had typical fractures that were treated by manipulation and immobilization in an extension cast. Two patients had atypical fractures with anterior displacement and posterior angulation of the distal fragment; they were treated by manipulation, but were more stable when immobilized with the elbow flexed with strapping and collar and cuff support. Overall, excellent or good results were achieved in 10 cases and poor results in four cases. Of the poor results, two were due to cubitus varus. These children were the only ones under 2 years of age, and in each the deformity was due to the persistence of an abnormally large Baumann angle. Plaster immobilization was inadequate at this stage. The other two poor results were due to mild stiffness of the elbow. For typical fractures, we conclude that excellent results can be expected in most children over the age of 2 years when treated with manipulation and immobilization in extension for 3 weeks. For the rarer atypical fractures, we conclude that excellent results can be expected after manipulation and immobilization in flexion for 3 weeks.

Adolescent↗
PubMed1991

Supracondylar fractures of the humerus in childhood: range of movement following the posterior approach to open reduction.

The posterior approach for open reduction of supracondylar fractures of the humerus has been condemned for causing decreased elbow movement. This study investigates this by comparing the range of movement in children treated by posterior open reduction and Kirschner wiring with those treated by closed reduction and immobilization. A total of 65 children with severely displaced supracondylar humeral fractures have been reviewed. There was some loss of movement in 66 per cent of the open reduction group and 42 per cent of the closed reduction group. The proportion losing more than 10 degrees of movement was the same in both groups. The difference between the two groups was due to the increased numbers in the open reduction group who lost less than 10 degrees of motion. Posterior open reduction of childhood supracondylar fractures is not associated with an important loss of elbow movement and need not be avoided on this account.

Adolescent↗
PubMed1993

Supracondylar fracture of the humerus: malrotation versus cubitus varus deformity.

A study correlating the degree of medial rotational deformity of the distal humerus and the degree of cubitus varus deformity secondary to supracondylar fracture was performed in 23 patients who underwent corrective supracondylar osteotomy. The mean age of the patients at the time of operation was 10.9 years (range 5-14 years). The time interval from injury to operation averaged 3.2 years (range 1-6 years). A medial rotational deformity occurred in 20 cases. The degree of medial rotational deformity (MRD) averaged 16.2 degrees (range 0-34 degrees). Mean carrying angles (CA) of the deformed and normal sides were -19.6 degrees and 6.5 degrees, respectively. Mean humero-elbow-wrist (HEW) angles, measured from radiographs, of the deformed and normal sides, were -18.8 degrees and 7.7 degrees, respectively. There was no correlation between the degree of MRD and the degree of varus deformity, using as a comparison either the CA or the HEW angle of the deformed elbow or their differences from the normal side.

Adolescent↗
PubMed1995

Operative treatment of type C intra-articular fractures of the distal humerus: the role of stability achieved at surgery on final outcome.

We report the results of 75 patients with type C intra-articular fracture of the distal humerus treated operatively by two methods and followed up for a mean period of 48.2 months. Minimal osteosynthesis and joint immobilization was used in 21 cases while the remaining 54 patients were treated according to AO recommendations. Good or excellent results were found in 38 per cent after minimal osteosynthesis and in 77.8 per cent following the AO technique. 87.8 per cent of the cases with stable osteosynthesis and early mobilization had a good or excellent result as compared with 41.2 per cent of the cases after unstable fixation and immobilization of the joint (P < 0.01). The type of fracture was found to be an important factor in achieving stable fixation (P < 0.01).

Adolescent↗
PubMed1995

Supracondylar fractures of the distal humerus in children.

An audit of 32 displaced supracondylar fractures of the humerus in children treated at the Glasgow Royal Infirmary between June 1990 and September 1992 was carried out. Six fractures were classified as Grade 2 (one cortex intact) and 26 were Grade 3 (no cortical contact). All grade 2 fractures were treated non-operatively with good results. Relatively poor results were obtained when displaced fractures were treated non-operatively with manipulation and plaster immobilization. Seven patients underwent manipulation and percutaneous pinning but two developed a cubitus varus deformity. Open reduction and internal fixation with two K-wires gave the best results with no deformity in ten patients. We therefore conclude that this is the optimal method of treatment in a hospital which deals with relatively few completely displaced fractures, with the cosmetic appearance of the scar being minimized by a medial approach.

Adolescent↗
PubMed1994

Fractures of the supracondylar process of the humerus.

The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.

Adolescent↗
PubMed2006

Pediatric supracondylar humerus fractures.

Pediatric supracondylar humerus fracture can occur in children and young teenagers; however, it is an injury seen most commonly between ages 5 and 8 years. Injuries tot he left arm are more common than to the right. Girls are affected as frequently as boys. Concurrent fractures in the same limb are possible, particularly fractures of the forearm and distal radius.

Arm↗