OBJECTIVE: To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. METHODS: A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups ( P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant difference in interval from injury to operation ( P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, the length of hospital stay, fracture healing time, elbow function assessed by Flynn criteria at 3 months after operation, and complications, were compared. RESULTS: Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss ( P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group, showing no significant difference between the two groups ( P>0.05). There was no significant difference in the fracture healing time between the two groups ( P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group ( P<0.05). In the early operation group, there was 1 case of fracture non-union and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was significant difference in the incidence of complications between the two groups ( P<0.05). One case of the early operation group and 10 cases of the delayed operation group underwent secondary operation, showing no significant difference in the incidence of secondary operation between the two groups ( P>0.05). CONCLUSION For pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.
Humans ; Humeral Fractures/surgery* ; Bone Wires ; Retrospective Studies ; Male ; Female ; Child ; Fracture Fixation, Internal/instrumentation* ; Child, Preschool ; Treatment Outcome ; Operative Time ; Fracture Healing ; Length of Stay ; Closed Fracture Reduction/methods* ; Blood Loss, Surgical ; Time Factors ; Time-to-Treatment ; Postoperative Complications/epidemiology*

OBJECTIVE: To investigate the difference of effectiveness between medial-lateral approach and posteromedian approach in the release of elbow stiffness after distal humeral fracture surgery. METHODS: A retrospective analysis was conducted on the clinical data of 41 patients with elbow stiffness following medial and lateral plate fixation for distal humeral fractures, admitted between January 2021 and June 2023 and meeting selection criteria. Patients were divided into the medial-lateral approach release group (study group, 20 cases) and the posteromedian approach release group (control group, 21 cases) based on surgical approach. Baseline data including age, gender, affected side, body mass index, disease duration, and preoperative extension angle, flexion angle, range of motion, visual analogue scale (VAS) pain score, Mayo elbow performance score, ulnar nerve symptoms, and heterotopic ossification showed no significant difference between groups ( P>0.05). The operation time, intraoperative blood loss, and complication incidence were recorded and compared between groups. Clinical effectiveness was evaluated using pre- and postoperative Mayo score, VAS score, elbow extension/flexion angles, and range of motion on the affected side. Statistical analysis focused on changes in these indicators relative to preoperative values. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Patients in both groups were followed up 15-36 months, with a mean of 23.8 months; there was no significant difference in the follow-up time between the two groups ( t=-1.542, P=0.131). In the control group, 1 patient had obvious subcutaneous hematoma and 5 patients had poor wound healing within 2 months after operation, all of which were cured by symptomatic treatment, while no related complications occurred in the study group, there was a significant difference in poor wound healing incidence between the two groups ( P<0.05). At last follow-up, 2 patients in the study group and 3 patients in the control group had mild symptoms of ulnar nerve numbness, and there was no significant difference in the incidence of ulnar nerve symptoms ( P>0.05). All patients had no recurrence or new onset of heterotopic ossification, no skin necrosis or reoperation due to complications. At last follow-up, elbow extension angle, flexion angle, flexion-extension range of motion, VAS score, and Mayo score significantly improved in both groups when compared with the preoperative ones ( P<0.05). There was no significant difference between the change values in elbow extension angle and VAS score between the two groups ( P>0.05); the change values in flexion angle, range of motion, and Mayo score in the study group were significantly better than those in the control group ( P<0.05). CONCLUSION The medial-lateral approach can release the elbow stiffness and concurrently remove the medial, lateral, or posterior lateral plates. The incision minimizes disruption to rehabilitation exercises and reduces complications like inadequate wound healing, ultimately leading to improved treatment outcomes.
Humans ; Humeral Fractures/surgery* ; Male ; Female ; Retrospective Studies ; Elbow Joint/physiopathology* ; Middle Aged ; Fracture Fixation, Internal/adverse effects* ; Range of Motion, Articular ; Adult ; Bone Plates ; Postoperative Complications/surgery* ; Treatment Outcome ; Aged ; Humeral Fractures, Distal

OBJECTIVE: To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus. METHODS: From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation. RESULTS: Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor. CONCLUSION Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.
Aged ; Female ; Humans ; Male ; Middle Aged ; Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fractures, Comminuted/surgery* ; Humeral Fractures/complications* ; Humeral Head ; Humerus ; Shoulder Fractures/surgery* ; Treatment Outcome ; Osteoporotic Fractures/surgery*

BACKGROUND: Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture. METHODS: This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy. RESULTS: All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100degrees in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients). CONCLUSIONS: Triangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.
Adult ; Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal/adverse effects/*methods/statistics & numerical data ; Humans ; Humeral Fractures/*surgery ; Intra-Articular Fractures/*surgery ; Male ; Middle Aged ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Treatment Outcome

Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.
Bone Wires ; adverse effects ; Foreign-Body Migration ; complications ; Humans ; Humeral Fractures ; surgery ; Hydropneumothorax ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.
Aged ; Bone Plates ; Female ; Fibula ; transplantation ; Fracture Fixation, Intramedullary ; methods ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications

The outward angulation of elbow with supinated forearm is cubitus varus deformity. This deformity is often seen as sequelae of malunited supracondylar fracture of humerus in paediatric age group of 5e8 years. The deformity is usually non-progressive, but in cases of physeal injury or congenital bony bar formation in the medial condyle of humerus, the deformity is progressive and can be grotesque in appearance. Various types of osteotomies are defined for standard non-progressive cubitus varus deformity, while multiple surgeries are required for progressive deformity until skeletal maturity. In this study we described a novel surgical approach and osteotomy of distal humerus in a 5 years old boy having grotesque progressive cubitus varus deformity, achieving good surgical outcome.
Child, Preschool ; Elbow Joint ; injuries ; Fractures, Malunited ; complications ; Humans ; Humeral Fractures ; complications ; Humerus ; surgery ; Joint Deformities, Acquired ; surgery ; Magnetic Resonance Imaging ; Male ; Osteotomy ; methods

PURPOSEFractures of the humeral shaft are common and account for 3%-5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors.

METHODSThe study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures.

RESULTSOf 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p=0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p=0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p =0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months.

CONCLUSIONContrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.

Adult ; Female ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Incidence ; Male ; Postoperative Complications ; epidemiology ; etiology ; Radial Neuropathy ; epidemiology ; etiology ; Retrospective Studies

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.
Brachial Artery ; diagnostic imaging ; injuries ; Child ; Humans ; Humeral Fractures ; complications ; diagnostic imaging ; surgery ; Male ; Tomography, X-Ray Computed

OBJECTIVETo retrospectively compare the occurrence of cubitus varus deformity after humeral supracondylar fractures treated with manipulative reduction and plaster fixation in pronated or supinated position in children, and to guide clinical treatment.

METHODSFrom June 2009 to December 2011, the medical data of 64 children with humeral supracondylar fractures treated by manipulative reduction and plaster fixation were reviewed. All the patients were divided into two groups: group A and group B. The 30 patients in group A were treated with manipulative reduction and plaster fixation in pronation, including 18 males and 12 females, with a mean age of (7.5 ± 3.5) years old. The 34 patients in group B were treated with manipulative reduction and plaster fixation in supination, including 23 males and 11 females, with a mean age of (7.0 ± 2.6) years old. The occurrence rates of cubitus varus and decreases of carrying angle were compared between two groups before and after treatment.

RESULTSThere were 13 patients in group A and 16 patients in group B having cubitus varus,which had no statistical difference (χ2 = 0.089, P = 0.765). The decrease of carrying angle were (8 ± 4) degrees in group A and (9 ± 5) degrees in group B, which had no statistical difference (t = 0.584, P = 0.564). Within group A, the occurrence rate of cubitus varus and the decrease of carrying angle between the radial deviation and the ulnar deviation had statistically significant difference (χ2 = 6.160, P = 0.013; t = - 2.409, P = 0.035). Within group B, the occurrence rate of cubitus varus and the decrease of carrying angle between the radial deviation and the ulnar deviation had statistically significant difference (χ2 = 5.120, P = 0.024; t = -2.250, P = 0.041). The elbow function Flynn evaluation score had no significant difference between two groups (P = -0.822).

CONCLUSIONThe occurrence rate of cybutys varys and the decrease of carrying angle have no obvious difference in children with humeral supracondylar fractures treated with fixation in pronated or supinated position. However, when treating with pediatrics humerus supracondylar fractures with ulnar deviation, the fixation in pronation is more helpful for reducing the occurrence rate of elbow varus and decrease of carrying angle. When treating with the pediatrics humerus supracondylar fractures with radial deviation, fixation in supination is helpful for reducing the occurrence rate of elbow varus and decrease of carrying angle.

Case-Control Studies ; Casts, Surgical ; Child ; Child, Preschool ; Elbow Joint ; injuries ; Female ; Humans ; Humeral Fractures ; surgery ; Joint Deformities, Acquired ; epidemiology ; Male ; Manipulation, Orthopedic ; Postoperative Complications ; epidemiology ; Prone Position ; Retrospective Studies ; Supine Position