Intraoperative situations in pediatric patients with supracondylar fracture of the humerus

Authors

Abstract

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient.
Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus.
Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years.
Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article.
Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

DeCS: HUMERAL FRACTURES, DISTAL/surgery; CHILD; SURGICAL PROCEDURES, OPERATIVE; OPEN FRACTURE REDUCTION; THERAPEUTICS.

Downloads

Download data is not yet available.

Author Biography

Alejandro Alvarez-López, Universidad de Ciencias Médicas. Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña. Departamento de Ortopedia y Traumatología. Camagüey, Cuba.

Médico ortopédico

References

1. Hosseinzadeh P, Rickert KD, Edmonds EW. What's new in pediatric orthopaedic trauma: the upper extremity. J Pediatr Orthop [Internet]. 2020 Apr [citado 18 Sep 2022];40(4):e283-e286. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31145183/

2. Suganuma S, Tada K, Takagawa S, Yasutake H, Takata M, Shimanuki K, et al. Independent predictors affecting the reduction of pediatric supracondylar humerus fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol [Internet]. 2021 Feb [citado 18 Sep 2022];31(2):399-406. Disponible en: https://link.springer.com/article/10.1007/s00590-020-02784-2

3. Wang JH, Morris WZ, Bafus BT, Liu RW. Pediatric supracondylar humerus fractures: AAOS appropriate use criteria versus actual management at a pediatric level 1 trauma center. J Pediatr Orthop [Internet]. 2019 Sep [citado 18 Sep 2022];39(8):[aprox. 7 p.]. Disponible en: https://journals.lww.com/pedorthopaedics/Abstract/2019/09000/Pediatric_Supracondylar_Humerus_Fractures__AAOS.5.aspx

4. Flynn JM. The management of complex pediatric fractures: case examples demonstrating 5 principles for success. J Pediatric Orthop [Internet]. 2018 Jul [citado 18 Sep 2022];38 (Suppl):S34-S38. Disponible en: https://journals.lww.com/pedorthopaedics/fulltext/2018/07001/the_management_of_complex_pediatric_fractures_.12.aspx

5. Tarallo L, Novi M, Porcellini G, Schenetti C, Micheloni GM, Maniscalco P, et al. Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice? Injury [Internet]. 2022 Mar [citado 18 Sep 2022];53 Suppl 1:[aprox. 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33678463/

6. Hussein-al Algawy AA, Aliakbar AH, Witwit IHN. Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children. J Orthop Surg Traumatol [Internet]. 2019 Feb [citado 18 Sep 2022];29(2):[aprox. 6 p.]. Disponible en: https://link.springer.com/article/10.1007/s00590-018-2305-9

7. Ismaili G, Mahmoud E, O' Toole P. A rare paediatric floating elbow; a supracondylar fracture with an ipsilateral Monteggia fracture: a case report. Int J Surg Case Rep [Internet]. 2022 May [citado 18 Sep 2022];94:[aprox. 9 p.]. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(22)00325-X

8. De Francesco CJ, Shah AS, Brusalis CM, Flynn K, Leddy K, Flynn JM. Rate of open reduction for supracondylar humerus fractures varies across pediatric orthopaedic surgeons: a single-institution analysis. J Orthop Trauma [Internet]. 2018 Oct [citado 18 Sep 2022];32(10):[aprox. 7 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30247284/

9. Lewine E, Kim JM, Miller PE, Waters PM, Mahan ST, Snyder B, et al. Closed versus open supracondylar fractures of the humerus in children: a comparison of clinical and radiographic presentation and results. J Pediatr Orthop [Internet]. 2018 Feb [citado 18 Sep 2022];38(2):[aprox. 4 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27100041/

10. Muchow RD, Riccio AI, Garg S, Ho CA, Wimberly RL. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children. J Pediatr Orthop [Internet]. 2015 Mar [citado 18 Sep 2022];35(2):[aprox. 4 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24919135/

11. Sun J, Shan J, Meng L, Liu T, Wang E, Jia G. Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children. BMC Musculoskelet Disord [Internet]. 2022 Sep [citado 18 Sep 2022];23(1):[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472328/

12. Armstrong DG, Monahan K, Lehman EB, Hennrikus WL. The pediatric open supracondylar fracture: associated injuries and surgical management. J Pediatr Orthop [Internet]. 2021 Apr [citado 18 Sep 2022];41(4):[aprox. 4 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33560707/

13. Kwak YH, Kim JH, Kim YC, Park KB. Medial comminution as a risk factor for the stability after lateral-only pin fixation for pediatric supracondylar humerus fracture: an audit. Ther Clin Risk Manag [Internet]. 2018 Jun [citado 18 Sep 2022];14:[aprox. 5 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995420/

14. Heffernan MJ, Lucak T, Igbokwe LBS, Yan JBS, Gargiulo D. The reverse oblique supracondylar humerus fracture: description of a novel fracture pattern. J Pediatric Orthop [Internet]. 2020 Feb [citado 18 Sep 2022];40(2):[aprox. 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31022014/

15. Wang SB, Lin BH, Liu W, Wei GJ, Li ZG, Yu NC, et al. Modified closed reduction and percutaneous Kirschner wires internal fixation for treatment of supracondylar humerus fractures in Children. Curr Med Sci [Internet]. 2021 Aug [citado 18 Sep 2022];41(4):[aprox. 4 p.]. Disponible en: https://link.springer.com/article/10.1007/s11596-021-2396-0

16. Karsli B, Ince K, Gönder N, Bozgeyik B, Kilinçoglu V. Surgery or conservative treatment of forearm in patients diagnosed with pediatric floating elbow? retrospective analysis of 60 consecutive cases. Indian J Orthop [Internet]. 2021 Jan [citado 18 Sep 2022];55(3):[aprox.6 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081788/

17. Stanitski CL, Micheli LJ. Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop Relat Res [Internet]. 1980 Nov-Dic [citado 18 Sep 2022];153:[aprox. 4 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7449219/

18. Egol KA, Koval KJ, Zuckerman J. Handbook of Fractures. 6 th ed. Philadelphia: Wolter Kluwer;2020.

19. Ho C. Upper extremity injuries. En: Herring JA, editors. Tachdajian's Pediatric Orthopaedics. 6 th ed. Philadelphia: Elsevier; 2022.p.1191-1247.

20. Moussa MK, Semaan D. A Pediatric floating elbow associating flexion type supracondylar fracture with both bone forearm fracture and ulnar nerve irritation: a case report. J Orthop Case Rep [Internet]. 2020 Dec [citado 18 Sep 2022];10(9):[aprox. 3 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046451/

21. Ndour O, Drame A, Faye Fall AL, Ndoye NA, Diouf C, Camara S, et al. Elbow floating in children: About three cases and literature review. Afr J Paediatr Surg [Internet]. 2020 Jul-Dec [citado 18 Sep 2022];17(3-4):[aprox. 4 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051627/

22. Blumberg TJ, Bremjit P, Bompadre V, Steinman S. Forearm fixation is not necessary in the treatment of pediatric floating elbow. J Pediatric Orthop [Internet]. 2018 Feb [citado 18 Sep 2022];38(2):[aprox. 5 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27203822/

23. Baghdadi S. Pediatric floating elbow injuries are not as problematic as they were once thought to be: a systematic review. J Pediatr Orthop [Internet]. 2020 Sep [citado 18 Sep 2022];40(8):[aprox. 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32776772/

24. Bahk MS, Srikumaran U, Ain MC, Erkula G, Leet AI, Sargent MC, et al. Patterns of pediatric supracondylar humerus fractures. J Pediatric Orthop [Internet]. 2008 Jul-Ago [citado 18 Sep 2022];28(5):[aprox.6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18580360/

25. Ondina AB, Haidar LA, Goldberg B, Mansour A 3rd, Younas S, Siahaan J, et al. Factors associated with conversion to open reduction of type 3 supracondylar humerus fractures in children. J Clin Orthop Trauma [Internet]. 2022 May [citado 18 Sep 2022];30:[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9163578/

26. Tokyay A, Okay E, Cansü E, Aydemir AN, Erol B. Effect of fracture location on rate of conversion to open reduction and clinical outcomes in pediatric Gartland type III supracondylar humerus fractures. Ulus Travma Acil Cerrahi Derg [Internet]. 2022 Jan [citado 18 Sep 2022];28(2):[aprox. 6 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443146/

27. Pan T, Widner MR, Chau MM, Hennrikus WL. Open supracondylar humerus fractures in Children. Cureus [Internet]. 2021 Mar [citado 18 Sep 2022];13(3):[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046429/

28. Su Y, Nan G. Evaluation of a better approach for open reduction of severe Gartland type III supracondylar humeral fracture. J Invest Surg [Internet]. 2021 May [citado 18 Sep 2022];34(5):[aprox. 6 p.]. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/08941939.2019.1649766?journalCode=iivs20

29. Uludag A, Tosun HB, Aslan TT, Uludag Ö, Gunay A. Comparison of three different approaches in pediatric Gartland type 3 supracondylar humerus fractures treated with cross-pinning. Cureus [Internet]. 2020 Jun [citado 18 Sep 2022];12(6):[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314373/

Downloads

Published

2024-01-09

How to Cite

1.
Alvarez-López A, Valdebenito-Aceitón V, Soto-Carrasco SR, Serrano-González D. Intraoperative situations in pediatric patients with supracondylar fracture of the humerus. Arch méd Camagüey [Internet]. 2024 Jan. 9 [cited 2025 Aug. 3];28:e9500. Available from: https://revistaamc.sld.cu/index.php/amc/article/view/9500

Issue

Vol. 28 (2024): Publicación continua

Section

Review Articles

License

Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.

Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.

(Download Statement of potential conflicts of interest)

The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).

This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/