IMMEDIATE CLOSED REDUCTION AND PERCUTANEOUS PINNING IN CHILDREN WITH DISPLACED TYPE 3 SUPRACONDYLAR FRACTURES OF THE HUMERUS: INVESTIGATION OF 258 CASES

Abstract

Introduction: The aim of this study was to investigate the results of the supracondylar fractures of the humerus which treated with closed reduction and percutaneous pinning with beginning early motion and to bring up our numerical values.
Patients and methods: Between the years of 1992 and 2000, 292 children with displaced supracondylar humerus fractures were treated with closed reduction and percutaneous pinning. All of the cases were opereted within 6 hours after hospitalizasyon. 10.9% of 293 (n=32) cases which stable fixation could not be achieved, treated with Over-Head skeletal traction, and %1.0 of 293 (n=3) cases which closed reduction coldn’t be achieved, treated with open reduction + internal fixation. This 35 cases and 34 patients who were lost during postoperative period, were abandoned out of study.In the last control, range of motion and carrying angle were measured with goniometre for each elbow, and anteroposterior, and lateral roentgenogram of effected side were obtained. The end results were classified on the basis of the clinical grading system developed by Flynn et al. For data analyse, SPSS version 10.0 packet statistic programme were used.
Results: There were 96.5% (n=249) extention type and 3.5% (n=9) flexion type. The average age of the patients was 6.95±2.93(1-13) years old. There were 71.7% (n=185) boys, 28.3% (n=73) girls and 60.5% (n=156) left-side 39.5%(n=102) right-side injuries. Hospital staying period averaged as 3.01 ± 1.66 (1-11) days, the mean duration of immobilization was 16.72 ± 2.27 (15-21) days and the mean follow-up period was 4.50 ± 2.48 (1-9) years. Preoperatively, there were associated neural injuries of the patients [ulnar 3.9% (n=10), radial 1.9% (n=5), median 1.2% (n=3)]. The radial pulse was not detectable in 10% (n=25) of the fractures before reduction. All fractures were found to have united without pain. There were 10% (n=25) superficial pin tract infections and 10.5% (n=27) ulnar nerve palsies associated with pinning. All pin tracks healed without evidence of deep infection and 89% of 27 (n=24) ulnar palsies had complete return of function. There were 4.2% (n=11) malunion [6 cubitus varus 2.3% (n=6), cubitus valgus 1.9%(n=5)], and 0.4% (n=1) compartment syndrome. According to the Flynn criterias, the clinical results was considered to be excellent in 76.8% (n=198) patients, good in 14.7% (n=38), fair in 3.5% (n=9) and poor in 5% (n=13).
Discussion: Our study had showed that closed reduction and percutaneos pinning was effective and safe in the treatment of Gartland type 3 fractures with high success rate and minimal complications. Medial pin placement has the risk of injuring the ulnar nerve, although it resolves spontaneously after removal of the pin.