Journal of Musculoskeletal Trauma

Original Articles

Treatment of Displaced Supracondylar Fracture of the Humerus in Children: Soon Hyuck Lee, Sang Won Park, Woong Kyo Jeong, Dae Hee Lee, Soon Yong Yoo; J Korean Fract Soc 2006;19(4):460-465. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.460

Abstract: PURPOSE
To evaluate the radiological and clinical outcomes after operative treatment of displaced supracondylar fractures in children with lateral K-wire fixation.
MATERIALS AND METHODS
69 displaced supracondylar fractures treated by closed reduction and percutaneous lateral K-wire fixation were included in this study. Carrying angle and range of motion were measured and graded by the Flynn criteria. To assess the accuracy of the reduction, Baumann angle and lateral humerocapital angles were compared to the contralateral side, and to evaluate the stability of fixation both measurements were taken immediately postoperatively and after K-wire removal.
RESULTS
55 cases (80%) were categorized as excellent and 12 cases (17%) as good. There were no significant statistical differences in Baumann angle and lateral humerocapital angle between postoperative and K-wire removal. Although there were 9 cases that showed differences in Baumann angle and 32 cases in lateral humerocapital angle of more than 10 degrees compared to the opposite side at the immediate postoperative radiograph, 9 cases showed satisfactory clinical results.
CONCLUSION
Closed reduction and lateral K-wire fixation is considered as an acceptable modality of the treatment of displaced supracondylar fractures in children, and clinical outcome is more closely correlated with carrying angle and stability of fracture site rather than rotational deformity or hyperextension of fragment measured radiographically.

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Double Tension Band Osteosynthesis in Supracondylar Fractures of the Humerus: Ho Jung Kang, Hong Hee Kim, Dong Joon Shim, Soo Bong Hahn, Eung Shick Kang; J Korean Soc Fract 2002;15(4):551-557. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.551

Abstract PDF: PURPOSE
This study evaluated the clinical result of supracondylar fractures of the humerus treated with double tension band osteosynthesis.
MATERIALS AND METHODS
From October 1992 to September 2001, 14 patients with supracondylar fractures of the humerus were treated by method of double tension band osteosynthesis. Eleven fractures were the results of slipped down injury and two traffic accidents and one direct trauma. All fractures were classified according to the AO fracture classification (A2; 2, A3; 1, C1; 6, C2; 3, C3; 2). There were 5 males and 9 females with average age of 51.6 years (range 15 to 88). Olecranon osteotomy was performed in 4 patients with severe comminuted fractures. Postoperative immobiliza-tions were required for an average of 20.6 days and consolidations were noted after an average of 10.1 weeks. Before operation, bone marrow density studies were performed in five fractures above 65 years. Average T-score of the patients were -3.65 on femur neck and -2.97 on lumbar spine. All patients were re-examined after an average of 16.4 months.
RESULTS
Union and consolidation was achieved in all 14 patients with no secondary displacement. In range of motion, eight patients judged their results as excellent and four as good. Ten patients had no pain and four had only occasional discomfort. Early removal of K-wires was performed in one patient because irritation of one side K-wires were develop. Sensory change of the ulnar nerve was noted in two patients. Anterior transposition of ulnar nerve was performed in one patient and the other was improved spontaneously. Skin necrosis was developed in one patient but was healed after pin removal and conservative care.
CONCLUSION
The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and more symmetrical compression than double plating. Therefore, in the commiuted osteoporotic fracture with poor tolerance for internal fixation with the plate or the simple supracondylar fractures in young age, double tension band osteosynthesis can provide sufficient and secure stability to allow early functional exercise.

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Neurologic recovery of neural injuries associated with supracondylar fractures of the humerus in children: Hyung Ku Yoon, Seoung Ju Jeon, Ho Seung Jun, Kye Nam Cho, Chul Won Kang; J Korean Soc Fract 2000;13(1):158-165. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.158

Abstract PDF: PURPOSE
: The purpose of our study in to determine the incidence of spontaneous recovery from neural injuries associated with supracondylar fractures of the humerus and to assess the results of electromyographic study and nerve conduction velocity. Material & methods : The 160 displaced supracondylar fractures of the humerus which had operation at the Sung Ae general hospital between April 1994 and 1998 were reviewed. Twelve(7.5%) were associated with complete neural injuries involving 16 nerves ; 9 radial, 5 ulnar and 2 median nerves. The mean age was 7.8 years old and boys outnumbered girls by 9 to 3. The follow-up period ranged from 1 year to 5 yeras 2 months. 11 fractures were managed with closed reduction and one with open means. All of the neural injuries were initially managed only by closed observation. At recent follow-up examination, we assessed the motor and sensory neurological status with Seddon's modification, grip strength and two-point discrimination in the autonomous zone. Electromyography(EMG) and nerve conduction velocity(NCV) were performed in 13 nerves of 10 patients who were assessed as complete recovered clinically.
Result
: Spontaneous neurological recovery occurred in 11 patients(15 nerves) at a mean of 2.4 months(range, 2 to 3.5 months.) Clinically, these nerves were assessed as normal. In the EMG and NCVs, 4 of 13 nerves resulted in adnormal findings. 2 radial and 1 ulnar nerve showed mild sensory neuropathy and 1 ulnar nerve showed mild denervation potentials in EMG and slow motor and sensory NCVs.
CONCLUSION
: We think that neural injuries associated with the displaced supracondylar fractures of the humerus tend towards spontaneous recovery within 4 months. And even though the neurologic recoveries are clinically complete, these are not always completely recovered in electromyographic study and nerve conduction velocity.

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Treatment of comminuted supracondylar fractures of the femur using Ilizarov method: Myung Chul Yoo, Yoon Je Cho, Ki Tack Kim, Young Soo Chun, Na Sil Pyo, Sung Gun Kim; J Korean Soc Fract 1999;12(3):529-537. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.529

Abstract PDF: PURPOSE
To evaluate the effectiveness of the Ilizarov method as a treatment of open or comminuted supracondylar fractures which are uncommon, and difficult to manage because of the wide range of potential complications.
MATERIALS and METHODS
Between 1992 and 1999, we treated open or comminuted supracondylar fractures of the femur by Ilizarov method in whole period or conversion to OR/IF with or without bone graft after transient Ilizarov fixation. There were 13 cases in 11 patients. Open comminuted fractures were seven cases and closed comminuted fracutres were six cases. We compared Ilizarov method in all procedures and temporary mode followed by internal fixation for definite care.
RESULTS
According to Schatzker and Lamberts assessment the results were good or excellent in ten cases(77%). And the results were rated as good or excellent in 67% of case of Ilizarov method in all procedures, and 86% of cases changed to OR/IF.
CONCLUSION
Ilizarov technique is an useful method in cases of open and/or comminuted supracondylar fractures of the femur. And after initial stabilization of fracture, conversion to OR/IF is advisable to prevent pin site infection and allow ROM excercise of the knee joint.

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Management of Displaced-Extension Type Supracondylar Fractures of Humerus in Children: Suk Myun Ko, Myung Ku Kim, Kyoung Ho Moon, Ryuh Sup Kim, Kyu Jung Cho, Dong Hun Choi; J Korean Soc Fract 1999;12(2):351-360. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.351

Abstract PDF: From June 1996 to February 1998, we reviewed the cases of 27 patients who had a displaced - extension type supracondylar fracture of the humerus retrospectively. The mean length of follow-up was 1.3 years. According to Gartland classification, type II was 7 cases (26%), type III-A was 11 cases (41%), type III-B was 9 cases (33%). We treated with three different methods, including closed reduction and percutaneous Kirschner-wire fixation, skeletal traction, and cast application after closed reduction. In type II fractures, we used two parallel lateral pins. In type III fractures, we used 2 lateral parallel pins followed by 1 medial crossed pin predominantly. The results of treatment were assessed using the criteria of Flynn et al. We graded cosmetic and functional factors separately. Satisfactory results were achieved by percutaneous K-wire fixation(96%). There were seven neural lesions. These were the result of injury and not of the treatment, with exception of one case. Neural injuries spontaneously resolved at a mean of 2.5 months(range 1.5 to 5 months) after injury. Varus deformity was present in one patient. There was no Volkman's ischemic contracture. Percutaneous Kirschnerwire fixation is advocated as the method of choice for the majority of displaced-extension type supracondylar humerus fractures in children.

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