Skip to main content

Advertisement

Log in

Screw fixation for supracondylar humerus fractures in children: a report of seventeen cases

  • Original Article • UPPER LIMB - PAEDIATRICS
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Supracondylar fractures in the pediatric population are common. For years, K-wires have been the preferred method of surgical fixation. However, fixation with K-wires alone may lead to multiple complications. This study reports the results of surgical care of supracondylar humerus fractures using screw fixation with K-wires or screw fixation alone.

Methods

This study retrospectively reviewed all patients with supracondylar humerus fractures treated with screw fixation between 2007 and 2013. Patients treated only with smooth wires, or having a displaced medial epicondyle, or presenting with lateral condyle fractures were excluded from the study. Flynn’s criteria were used to determine the outcome.

Results

Seventeen patients who met inclusion criteria formed the study group. All patients were followed until union, resolution of complications, and return to preinjury activity level. Satisfactory outcome was reported in 70.6% of patients with less than 15° loss of either flexion or extension. Mean time to union was 6.5 weeks (range 3.3–12.1 weeks). Screw fixation alone had a shorter mean time to union (5.5 weeks) than compared screw fixation with K-wires group (6.9 weeks). Full range of motion following surgical invention was associated with Flynn’s criteria (p value = 0.044).

Conclusion

Screw fixation for pediatric supracondylar fractures is a viable option to achieve healing and early motion in highly unstable fractures as well as fractures which require (1) increased stability, (2) maintenance of stability during wound checks in the immediate postoperative period and after discontinuation of the cast, or (3) if further exploration like associated vascular injury is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Shrader MW (2008) Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 39(2):163–171. https://doi.org/10.1016/j.ocl.2007.12.005

    Article  PubMed  Google Scholar 

  2. Launay F, Leet AI, Jacopin S, Jouve JL, Bollini G, Sponseller PD (2004) Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Pediatr Orthop 24(4):385–391

    Article  Google Scholar 

  3. Schlitz RS, Schwertz JM, Eberhardt AW, Gilbert SR (2015) Biomechanical analysis of screws versus K-wires for lateral humeral condyle fractures. J Pediatr Orthop 35(8):e93–e97. https://doi.org/10.1097/BPO.0000000000000450

    Article  PubMed  Google Scholar 

  4. Flynn JC, Matthews JG, Benoit RL (1974) Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 56(2):263–272

    Article  CAS  Google Scholar 

  5. Team RC (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  6. Alburger PD, Weidner PL, Betz RR (1992) Supracondylar fractures of the humerus in children. J Pediatr Orthop 12(1):16–19

    Article  CAS  Google Scholar 

  7. Ersan O, Gonen E, Ilhan RD, Boysan E, Ates Y (2012) Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children. J Pediatr Orthop B 21(2):121–126. https://doi.org/10.1097/BPB.0b013e32834dd1b2

    Article  PubMed  Google Scholar 

  8. Lee SS, Mahar AT, Miesen D, Newton PO (2002) Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop 22(4):440–443

    PubMed  Google Scholar 

  9. Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109(2):145–154

    CAS  PubMed  Google Scholar 

  10. Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman CT, Scherl S, Goldberg M, Turkelson CM, Wies JL, Boyer K, American Academy of Orthopaedic Surgeons (2012) The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 20(5):320–327. https://doi.org/10.5435/JAAOS-20-05-320

    Article  PubMed  Google Scholar 

  11. Loke WP, Shukur MH, Yeap JK (2006) Screw osteosynthesis of displaced lateral humeral condyle fractures in children: a mid-term review. Med J Malaysia 61(Suppl A):40–44

    PubMed  Google Scholar 

  12. Ring D, Gulotta L, Jupiter JB (2003) Unstable nonunions of the distal part of the humerus. J Bone Joint Surg Am 85-A(6):1040–1046

    Article  Google Scholar 

  13. Gilbert SR, MacLennan PA, Schlitz RS, Estes AR (2016) Screw versus pin fixation with open reduction of pediatric lateral condyle fractures. J Pediatr Orthop B 25(2):148–152. https://doi.org/10.1097/BPB.0000000000000238

    Article  PubMed  Google Scholar 

  14. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH (2001) The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am 83-A(3):323–327

    Article  Google Scholar 

  15. Li WC, Xu RJ (2012) Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Int Orthop 36(6):1261–1266. https://doi.org/10.1007/s00264-011-1452-y

    Article  PubMed  Google Scholar 

  16. Brubacher JWDS (2008) Pediatric supracondylar fractures of the distal humerus. Curr Rev Musculoskelet Med 1(3–4):190–196. https://doi.org/10.1007/s12178-008-9027-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smith JT, Kasser JR, Waters PM et al (2008) The effect of pinning across the physis for stabilization of fractures in children: an MRI evaluation. Orthop J Harv Med Sch. 10:99–102

    Google Scholar 

  18. Kamath AF, Cody SR, Hosalkar HS (2009) Open reduction of medial epicondyle fractures: operative tips for technical ease. J Child Orthop 3(4):331–336. https://doi.org/10.1007/s11832-009-0185-6

    Article  PubMed  PubMed Central  Google Scholar 

  19. Davis RT, Gorczyca JT, Pugh K (2000) Supracondylar humerus fractures in children. Comparison of operative treatment methods. Clin Orthop Relat Res 376:49–55

    Article  Google Scholar 

  20. Sankar WN, Hebela NM, Skaggs DL, Flynn JM (2007) Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am 89(4):713–717. https://doi.org/10.2106/JBJS.F.00076

    Article  PubMed  Google Scholar 

  21. Yaokreh JB, Odehouri-Koudou TH, Tembely S, Dieth AG, Kouame DB, Ouattara O, Dick KR (2012) Delayed treatment of supracondylar elbow fractures in children. Orthop Traumatol Surg Res 98(7):808–812. https://doi.org/10.1016/j.otsr.2012.07.005

    Article  CAS  PubMed  Google Scholar 

  22. Mehlman CT, Crawford AH, McMillion TL, Roy DR (1996) Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg 62(Suppl 1):41–50

    PubMed  Google Scholar 

  23. Kasser JR (1992) Percutaneous pinning of supracondylar fractures of the humerus. Instr Course Lect 41:385–390

    CAS  PubMed  Google Scholar 

  24. Boyd DW, Aronson DD (1992) Supracondylar fractures of the humerus: a prospective study of percutaneous pinning. J Pediatr Orthop 12(6):789–794

    Article  CAS  Google Scholar 

  25. Alam WRS, Jan R, Hussain S (2014) Outcome of open reduction and internal fixation of Supracondylar fractures of humerus in children with lateral approach. Pak J Surg 30(2):146–149

    Google Scholar 

  26. Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL (2009) A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 29(6):602–605. https://doi.org/10.1097/BPO.0b013e3181b2842c

    Article  PubMed  Google Scholar 

  27. Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM (2004) Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 86(4):702–707

    Article  Google Scholar 

  28. Skak SV, Olsen SD, Smaabrekke A (2001) Deformity after fracture of the lateral humeral condyle in children. J Pediatr Orthop B 10(2):142–152

    CAS  PubMed  Google Scholar 

  29. Ippolito E, Caterini R, Scola E (1986) Supracondylar fractures of the humerus in children Analysis at maturity of fifty-three patients treated conservatively. J Bone Joint Surg Am 68(3):333–344

    Article  CAS  Google Scholar 

  30. Tellisi N, Abusetta G, Day M, Hamid A, Ashammakhi N, Wahab KH (2004) Management of Gartland’s type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury 35(11):1167–1171. https://doi.org/10.1016/j.injury.2004.01.006

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sherif Dabash.

Ethics declarations

Conflict of interest

All authors have no relevant conflicts of interest to disclose. There was no pharmaceutical or industry support for this investigation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dabash, S., Gerzina, C., Prabhakar, G. et al. Screw fixation for supracondylar humerus fractures in children: a report of seventeen cases. Eur J Orthop Surg Traumatol 29, 575–581 (2019). https://doi.org/10.1007/s00590-018-2316-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-018-2316-6

Keywords

Navigation