Characterization of supracondylar fractures of the humerus in children who required surgical management at a hospital in Santander, Colombia.
Abstract
Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8 % were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. In the study didn’t inform vascular injuries; however, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve.
References
Olalde HM, Viveros AL, Castro JS, Ávila FM, Milán NJ, Gómez V, et al. Fracturas supracondíleas en niños, tratamiento quirúrgico. Rev Mex Ortop Ped [Internet]. 2007;9(1):10-12. Recuperado a partir de: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=13072
Meza-Santini JF. Fractura supracondílea humeral en niños. Ortho-tips [Internet]. 2009;5(3):218-25. Recuperado a partir de: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=22453
Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev [Internet]. 2018;3(10):526-450. doi: https://doi.org/10.1302/2058-5241.3.170049
Heras J, Durán D, de la Cerda J, Romanillos O, Martínez-Miranda J, Rodríguez-Merchán EC, et al. Supracondylar Fractures of the Humerus in Children. Clin. Orthop. Rel. Res [Internet]. 2005;432:57-64. doi: https://doi.org/10.1097/01.blo.0000155373.03565.78
Zaltz I, Waters PM, Kasser JR. Ulnar Nerve Instability in Children. J. Pediatr. Orthop [Internet]. 1996;16(5):567-9. doi: https://doi.org/10.1097/01241398-199609000-00003
Edmonds EW, Roocroft JH, Mubarak SJ. Treatment of Displaced Pediatric Supracondylar Humerus Fracture Patterns Requiring Medial Fixation: a Reliable and Safer Cross-pinning Technique. J. Pediatr. Orthop [Internet]. 2012;32(4):346-51. doi: https://doi.org/10.1097/BPO.0b013e318255e3b1
Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture Stability After Pinning of Displaced Supracondylar Distal Humerus Fractures in Children. J. Pediatr. Orthop [Internet]. 2001;21(3):313-8. doi: https://doi.org/10.1097/01241398-200105000-00010
Rees AB, Schultz JD, Wollenman LC, Moore-Lotridge SN, Martus JE, Schoenecker JG, et al. A Mini-open Approach to Medial Pinning in Pediatric Supracondylar Humeral Fractures May Be Safer than Previously Thought. JBJS [Internet]. 2022;104(1):33-40. doi: https://doi.org/10.2106/JBJS.21.00301
Villamizar P, Guzmán V, Valencia A. Características sociodemográficas, clínicas y anatómicas de menores de 18 años que consultan por trauma musculoesquelético al Hospital Universitario de Santander de julio 2010 a junio 2011. [Tesis de especialización]. Bucaramanga, Santander (Colombia): Universidad Industrial de Santander; 2013.
Patriota GSQA, Assunção-Filho CA, Assunção CA. What is the best fixation technique for the treatment of supracondylar humerus fractures in children? Rev bras ortop [Internet]. 2017;52(4):428-34. doi: https://doi.org/10.1016/j.rboe.2017.05.013
Shenoy PM, Islam A, Puri R. Current Management of Paediatric Supracondylar Fractures of the Humerus. Cureus [Internet]. 2020;12(15);e8137. Recuperado a partir de: https://assets.cureus.com/uploads/review_article/pdf/28278/1612429828-1612429823-20210204-18203-1h00kak.pdf
Saeed W, Waseem M. Elbow Fractures Overview. In:Stat Pearls [Internet]. 2022. Recuperado a partir de: https://europepmc.org/article/nbk/nbk441976
Fernandes-Jr JCF, Milan TV, Ribeiro HAM, Stein HE, Ribas-Filho HC, Carula BC. Distal Humeral Fracture: An Epidemiological Analysis of Orthopedic Patients for Children. Acta Ortop Bras [Internet]. 2019;27(5):261-4. doi: https://doi.org/10.1590/1413-785220192705215825
Caso-García A, López-Fernández P, Cimadevilla-González MP, Núñez-Batalla D, Paz-Jiménez J. Tratamiento de las fracturas supracondíleas de húmero con desplazamiento en niños. Revista Española de Cirugía Osteoarticular [Internet]. 1999;34(200):201–8. Recuperado a partir de: http://www.cirugia-osteoarticular.org/revistas/usuario/articulos/articulo.asp?idarticulo=198
Martínez-Cano JP, Zamudio-Castilla L, Mantilla JC, Caicedo DC, Vernaza-Obando D, Martínez-Rondanelli A. Fracturas en niños: experiencia en un centro de alta complejidad del suroccidente colombiano. Rev. Univ. Ind. Santander. Salud [Internet]. 2019;51(4):309-15. doi: https://doi.org/10.18273/revsal.v51n4-2019004
Anari JB, Neuwirth AL, Carducci NM, Donegan DJ, Baldwin KD. Pediatric T- Condylar Humerus Fractures: a Systematic Review. J. Pediatr. Orthop [Internet]. 2017;37(1):36-40. doi: https://doi.org/10.1097/BPO.0000000000000588
Salvador J, Nuñez JH, Veloso M, Castillón P, Angles F. Newcastle approach for the treatment of supra-intercondylar fractures in children. Trauma Case Reports [Internet]. 2020;25:100270. doi: https://doi.org/10.1016/j.tcr.2019.100270
Ducic S, Stojanovic B, Lazovic M, Bukva B, Radlovic V, Bumbasirevic V, et al. T- condylar humerus fracture in children: treatment options and outcomes. Int. Orthop [Internet]. 2021;45:1065-70. doi: https://doi.org/10.1007/s00264-020-04827-z
Başbuğ HS, Göçer H, Özışık K. Surgical treatment of pulseless pediatric supracondylar humerus fracture. Int J Cardiovasc Acad [Internet]. 2017;3:31-3. doi: https://doi.org/10.1016/j.ijcac.2017.05.002
Cespedes LJ, Turriago C, Goyeneche J. Línea de pliegue antecubital interno: Un nuevo reparo anatómico útil para identificar la epitróclea y evitar lesiones iatrogénicas del nervio ulnar en pacientes con fractura supracondílea del húmero. Rev. Univ. Ind. Santander. Salud [Internet]. 2012;44(2):9-14. Recuperado de: https://www.redalyc.org/articulo.oa?id=343835705003
Prashant K, Lakhotia D, Bhattacharyya TD, Mahanta AK, Ravoof A. A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus. J Orthopaed Traumatol [Internet]. 2016;17:223-9. doi: https://doi.org/10.1007/s10195-016-0410-2
Vega-Fernández E, Tórrez-Hernández ME, Martínez-Mesa J. Fractura supracondílea de codo en extensión en niños. Rev Cubana Ortop Traumatol [Internet]. 2006;20(2). Recuperado a partir de: http://scielo.sld.cu/scielo.php?pid=S0864-215X2006000200003&script=sci_arttext
Rodríguez-Ramírez CL, Águila-Mendoza A. Anatomía del codo por imagen de resonancia magnética. Acta Ortop Mex [Internet]. 2011;25(4):246-52. Recuperado a partir de: https://www.medigraphic.com/pdfs/ortope/or-2011/or114j.pdf
Ortiz D, Useche LF, Castellanos C, Estrada C. Resultados del manejo de la fractura supracondílea Gartland de tipo III en una institución pediátrica. Rev Colomb Ortop Traumatol [Internet]. 2017;31(4):167-71. doi: https://doi.org/10.1016/j.rccot.2017.06.010
Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic Ulnar Nerve Injury After the Surgical Treatment of Displaced Supracondylar Fractures of the Humerus: Number Needed to Harm, A Systematic Review. J Pediatr Orthop [Internet]. 2010;30(5):430-6. doi: https://doi.org/10.1097/BPO.0b013e3181e00c0d
Skaggs DL. Elbow Fractures in Children: Diagnosis and Management. J Am Acad Orthop Surg [Internet]. 1997;5:303-12. doi: https://doi.org/10.5435/00124635-199711000-00002
Peña-Cardona CJ, Medina-Madrid LM, Trujillo-González CI, Peña-López AD, González-González V. Actualización en fracturas supracondíleas del codo en la infancia. [Internet]. Medicina UPB [Internet] 2020;39(1):57-70. doi: https://doi.org/10.18566/medupb.v39n1.a09
Turhal O, Kınaş M, Karaduman ZO, Turhan Y, Kaya O, Güler C. Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures. Medicina [Internet]. 2019;55(8):450. doi: https://doi.org/10.3390/medicina55080450
Wong KPL, Chew EM, Mahadev A. Sliding the Medial Pin: A Safer Approach to Cross-pinning Humerus Supracondylar Fractures? Tech Hand Surg [Internet]. 2019;23(3):111-4. doi: https://doi.org/10.1097/BTH.0000000000000230
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