Journal of Musculoskeletal Trauma

Comparison of Treatment Methods in Gartland Type III Pediatric Supracondylar Humeral Fracture: Lateral Entry Pin versus Crossed-Pin Technique: Young Hoon Jo, Tai Seung Kim, Dong Yun Kim; J Korean Fract Soc 2015;28(3):186-193. Published online July 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.3.186

Abstract PDF: PURPOSE
The aim of this study was to compare the results of the lateral entry pin technique and the crossed pin technique in treatment of Gartland type III humerus supracondylar fracture.
MATERIALS AND METHODS
Seventeen patients (group I) underwent surgery using the lateral entry pin technique, and 33 patients (group II) underwent surgery using the crossed pin technique for Gartland type III humerus supracondylar fracture in Hanyang University Seoul Hospital between January 2011 and January 2014. Maintenance of reduction was compared between the 2 surgical techniques by measuring changes in Baumann angle and lateral humerocapitellar angle after surgery and after pin removal in groups I and II. In addition, the final carrying angle and level of loss of functional movement were measured for comparison of clinical results between the 2 groups. Occurrence of ulnar nerve palsy in the 2 groups was also examined.
RESULTS
The mean Baumann angle and lateral humerocapitellar angle changes were 3.3degrees and 3.7 in group I and 3.1degrees and 3.4degrees in group II, respectively. No statistically significant differences were found between the 2 groups. Clinical results showed that the changes in the final carrying angle and range of motion were 2.9degrees and 2.6degrees in group I and 2.6degrees and 3.0degrees in group II, respectively, indicating no significant differences between the 2 groups. In terms of nerve damage, 1 patient in group II had temporary iatrogenic ulnar nerve palsy.
CONCLUSION
The lateral entry pin technique may be regarded as an appropriate treatment that reduces the risk of iatrogenic ulnar nerve palsy and provides satisfactory results in Gartland type III humerus supracondylar fracture patients.

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Treatment of Femur Supracondylar Fracture with Locking Compression Plate: Seong Ho Bae, Seung Han Cha, Jeung Tak Suh; J Korean Fract Soc 2010;23(3):282-288. Published online July 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.3.282

PURPOSE
To evaluate the effectiveness of locking compression plate by analyzing the clinical outcomes of open reduction and internal fixation with locking compression plate in the treatment of femur supracondylar fracture.
MATERIALS AND METHODS
We reviewed 21 cases of distal femur fractures which were treated with locking compression plate in our hospital from February 2005 to March 2009 and followed up for minimal 1 year. The types of fractures were seven A1, four A2, two A3, six C2, and two C3 according to AO classification. 2 cases were open fractures. The cases were evaluated by the criteria of Schatzker-Lambert.
RESULTS
The mean time to union was 14.3 weeks. One delayed union, one refracture were observed, but no nonunion and postoperative infection was observed. The outcomes were excellent in 6 cases, good in 11, fair in 3, and failure in 1 by the criteria of Schatzker-Lambert. The overall results were excellent or good in 17 cases (81.0%).
CONCLUSION
In the treatment of femur supracondylar fracture, open reduction and internal fixation with locking compression plate yields good result and locking compression plate is useful choice of fixation option.

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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture: Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park; J Korean Fract Soc 2010;23(1):90-96. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.90

Abstract PDF: PURPOSE
To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view.
MATERIALS AND METHODS
A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared.
RESULTS
Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II.
CONCLUSION
Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.

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Surgical Treatment of the Myositis Ossificans in Supracondylar Fracture of the Humerus in Children: A Case Report: Tai Seung Kim, Kee Cheol Park, Seung Pyo Seo; J Korean Fract Soc 2006;19(4):482-485. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.482

Abstract

Supracondylar fracture of the humerus is a common injury in the pediatric patient. A less common complication is the development of myositis ossificans. Although frequently cited as a possible complication, there are few reported cases of this occurring in the pediatric patient. We present a case report of a 8 year old boy who developed myositis ossificans after a supracondylar fracture of the humerus. After one year of the injury, we could ascertained radiologically complete maturation of the mass which developed in front of the distal humerus and markedly made motion of the elbow joint limited. We could obtain further motion through the surgical resection and then physical therapy. Now, eleven months have lapsed since the mass was removed, the range of motion is almost normal, and the recurrence of myositis ossificans is not existed.

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Recent Trends in Treatment of Supracondylar Fracture of Distal Humerus in Children
Soon Chul Lee, Jong Sup Shim
Journal of the Korean Fracture Society.2012; 25(1): 82. CrossRef

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Treatment of Displaced Supracondylar Fracture of the Humerus in Children: Soon Hyuck Lee, Sang Won Park, Woong Kyo Jeong, Dae Hee Lee, Soon Yong Yoo; J Korean Fract Soc 2006;19(4):460-465. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.460

Abstract: PURPOSE
To evaluate the radiological and clinical outcomes after operative treatment of displaced supracondylar fractures in children with lateral K-wire fixation.
MATERIALS AND METHODS
69 displaced supracondylar fractures treated by closed reduction and percutaneous lateral K-wire fixation were included in this study. Carrying angle and range of motion were measured and graded by the Flynn criteria. To assess the accuracy of the reduction, Baumann angle and lateral humerocapital angles were compared to the contralateral side, and to evaluate the stability of fixation both measurements were taken immediately postoperatively and after K-wire removal.
RESULTS
55 cases (80%) were categorized as excellent and 12 cases (17%) as good. There were no significant statistical differences in Baumann angle and lateral humerocapital angle between postoperative and K-wire removal. Although there were 9 cases that showed differences in Baumann angle and 32 cases in lateral humerocapital angle of more than 10 degrees compared to the opposite side at the immediate postoperative radiograph, 9 cases showed satisfactory clinical results.
CONCLUSION
Closed reduction and lateral K-wire fixation is considered as an acceptable modality of the treatment of displaced supracondylar fractures in children, and clinical outcome is more closely correlated with carrying angle and stability of fracture site rather than rotational deformity or hyperextension of fragment measured radiographically.

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Treatment of Pediatric Displaced Supracondylar Fractures of the Humerus by Pin Leverage Technique: Han Yong Lee, Joo Hyoun Song; J Korean Fract Soc 2006;19(1):83-88. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.83

Abstract

PURPOSE
To evaluate a new treatment method by pin leverage technique in Gartland type III fractures to avoid forceful manipulation or open reduction.
MATERIALS AND METHODS
99 cases were included in this study and divided into 3 groups (I;open reduction, II; closed reduction and percutaneous pin fixation, III; pin leverage technique), and we analyzed timing to operation, length of operation, associated neurovascular injuries, complications, and clinical and radiological outcomes at final follow-up.
RESULTS
The average length of operation 119, 57, and 68 minutes respectively. The associated nerve injuries were 8, 2, and 2 cases respectively. There were a case of superficial pin tract infection in group I, three cases of superficial pin tract infection and a case of iatrogenic ulnar nerve injury in group II. At final follow-up, clinical results were excellent or good in all cases and there were 5 cases (8.3%) of fair results in group II radiologically. Closed reduction with pin leverage technique were failed in 5 cases.
CONCLUSION
In treatment of Gartland type III fractures, pin leverage reduction technique is considered to be a good alternative prior to open reduction, because it provides shortened length of operation, avoidance of forceful manipulation and open reduction.

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Recent Trends in Treatment of Supracondylar Fracture of Distal Humerus in Children
Soon Chul Lee, Jong Sup Shim
Journal of the Korean Fracture Society.2012; 25(1): 82. CrossRef

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Minimally Invasive Anterior Approach in Open Reduction of Displaced Supracondylar Fractures of Humerus in Children: Chang Ryung Hur, Seung Woo Suh, Chang Ug Oh, In Jung Chae, Jun Gyu Moon, Chan Eung Park, Jae Young Hong; J Korean Fract Soc 2005;18(2):185-190. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.185

Abstract PDF

PURPOSE
To evaluate the outcomes of minimal anterior approach and thumb assisted technique, in children with Gartland type III supracondylar humerus fracture, who were operated by this technique.
MATERIALS AND METHODS
Forty two children with Gartland type III supracondylar fractures of the humerus with severe swelling were taken up for minimal open reduction and K-wire fixation. The technique used was a minimal incision in the cubital fossa and thumb assisted reduction of the fracture. Stabilization of fractures was done with 1.6 mm Kirschner wires.
RESULTS
The outcomes were excellent in 40 cases good in 2 cases. No complications including malunion or scar contracture were seen.
CONCLUSION
This technique is safe, effective and can be used for irreducible, displaced supracondylar fractures of the humerus in children

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Supracondylar Humerus Fractures: Classification Based Treatment Algorithms
Mudit Shah, Mandar Vikas Agashe
Indian Journal of Orthopaedics.2021; 55(1): 68. CrossRef
Recent Trends in Treatment of Supracondylar Fracture of Distal Humerus in Children
Soon Chul Lee, Jong Sup Shim
Journal of the Korean Fracture Society.2012; 25(1): 82. CrossRef
Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique
H.-Y. Lee, S.-J. Kim
The Journal of Bone and Joint Surgery. British volume.2007; 89-B(5): 646. CrossRef

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The Percutaneous Pinning of the Displaced Supracondylar Fracture of the Humerus using Skin Traction: In Heon Park, Kyung Won Song, Sung Il Shin, Jin Young Lee, Seung Yong Lee, Won Seok Oh; J Korean Fract Soc 2004;17(2):65-69. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.65

Abstract PDF

PURPOSE
The purpose of this study was to evaluate a new treatment method, which was using intraoperative skin traction and Steinmann(S)-pin for anatomically reduction by gentle manipulation to treat the displaced supracondylar fracture of the humerus with percutaneous pinning.
MATERIALS AND METHODS
Clinical analysis was performed on thirty displaced supracondylar fractures (Gartland type III) of the humerus patients with a minimal three month follow up, who were treated percutaneous pinning after reduction with by intraoperative skin traction and S-pin. Clinical results were analyzed according to the Flynn grading system.
RESULTS
According to the Flynn grading system, excellent results were obtained in 12 cases (43%), good in 14 case (47%), fair in 4 cases (10%), poor in 0 cases (0%) and we obtained all satisfactory results. There was one case which was reoperated for closed reduction and percutaneous pinning repeatedly due to reduction loss and no case with conversion to open reduction.
CONCLUSION
To avoid the forceful manipulation, gentle closed reduction and percutaneous pinning using intraoperative skin traction and S-pin especially for rotational correction in the displaced supracondylar fracture of the humerus is considered to be useful method because showed satisfactory results.

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Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique
H.-Y. Lee, S.-J. Kim
The Journal of Bone and Joint Surgery. British volume.2007; 89-B(5): 646. CrossRef

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Retrograde Nailing in Femur Supracondylar Fracture: Jin Woo Kwon, Sung Ho Shin, Won Ho Cho, Ki Ho Sung, Ki Han Kim, Kyong Tae Sohn, Sang Hoon Lee, Se Won Park, Jong Moon Bae, Tae Woo Kwon; J Korean Soc Fract 2003;16(4):465-473. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.465

Abstract PDF

PURPOSE
We retrospectively analysed the result of retrograde supracondylar nail fixation in femur supracondylar fractures and evaluate the clinical effectiveness of this method.
MATERIALS AND METHODS
Since October 1998 we have treated 14 supracondylar fractures (AO type: A2-6, A3-1, C1-3 and C2-4) by retrograde intramedullary nailing technique through trans-patellar tendon approach from October 1998 to June 2001 and followed more than 1 year.
RESULTS
Among 14 cases, 5 cases were excellent, 6 good, 3 fair according to Schatzker functional result. The complications were 1 distal locking screw loosening, 1 delayed union and 1 fracture around proximal locking site.
CONCLUSION
Even though the retrograde nailing may damage the knee joint because it is inserted by opening up the joint, it provided the necessary stable fixation with short operation time, low blood loss, minimal soft tissue injury. Thus we believe that retrograde nailing is useful operative technique for the management of supracondylar fracture in osteoporotic, communited fractures, or open fractures.

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Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail
Moon-Jib Yoo, You-Jin Kim, Jin-Won Lee
Journal of the Korean Fracture Society.2008; 21(1): 19. CrossRef

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Displaced Supracondylar Fractures of the Humerus in Children Treated by Percutaneous Lateral K-wire Pinning: Soon Hyuck Lee, Sang Won Park, Kwang Suk Lee, Jong Ryoon Baek, Sang Won Lee; J Korean Soc Fract 2003;16(3):392-398. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.392

Abstract PDF

PURPOSE
For the treatment of displaced children supracondylar fractures, closed reduction and lateral pinning were performed consecutively and their results were analyzed.
MATERIALS AND METHODS
During the period from January 1997 to May 2001, all children with displaced supracondylar fractures of the humerus were treated by closed reduction and lateral K-wire pinning. Among them, 44 fractures with more than 1 year follow up were selected. Carrying angle and range of motion were measured. Baumann angle and lateral humerocapital angles were measured from the anteroposterior and lateral radiograph 3 times (immediate post op, K-wire removal, last follow up).
RESULTS
Results were graded according to the criteria of Flynn et al. using both cosmetic and functional evaluation. According to the cosmetic factor, 36 cases (82%) were excellent and 8 cases (18%) were good. According to the functional factor, 39 cases (88%) were excellent and 5 cases (12%) were good. No statiscally significant differences, as seen on Baumann and humerocapital angle, between immediate post operative films and films taken at the time of K-wire removal (p=0.082, p=0.27). There was no significant differences in Baumann and humerocapital angle at the time of K-wire removal and last follow up (p=0.19, p=0.27).
CONCLUSION
Closed reduction and lateral K-wire pinning is considered as an acceptable modality of the treatment of displaced children supracondylar fractures.

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Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique
H.-Y. Lee, S.-J. Kim
The Journal of Bone and Joint Surgery. British volume.2007; 89-B(5): 646. CrossRef

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The Analysis of the Percutaneuos Pinning of Supracondylar Fractures in Children: SangMok Lee, SoHak Jung, JaeHo Jang, JungHwan Son, JaeDo Kim; J Korean Soc Fract 2003;16(2):284-291. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.284

Abstract PDF: PURPOSE
Supracondylar fracture was known as supracondylar dilema because of complication and difficulty in treatment. Many methods were devised to prevent and minimize the complications. Among the treatment methods, closed reduction and percutaneous pinning was widely used for most of supracondylar fractures. But arguments was existed for the the pinning methods such as pinning site and number of pins.
MATERIALS AND METHODS
We reviewed 44 cases of displaced supracondylar fractures treated by closed reduction and percutaneous pining. The pins were removed about 4~5 weeks after operation and range of motion was begun. All cases was reviewed restropectively and results was analysed by Flynn grading system. The pinning method was analysed.
RESULTS
There were no significant clinical results among the methods of percutaneous pinnings. Even though two crossed pins from the lateral and medial condyles were preferable for most fractures. The results are that 1)At least 2 K-wires were needed. 2)Prognosis was not influenced by the pinning site. 3)The complication was prevented by accurate reduction using image intensifier during operation.
CONCLUSION
Two lateral parallel pins were alternative method for marked swelling and severely displaced fractures.

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Flexion-type Humerus Supracondylar Fractures in Children: Jae Do Kang, Kwang Yul Kim, Hyung Chun Kim, Moon Sup Lim, Shin Kwon Choi, Hyun Soo Park; J Korean Soc Fract 2002;15(4):601-606. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.601

Abstract PDF: PURPOSE
We investigated the treatment modality and clinical results in flexion-type supracondylar fractures of the humerus in children.
MATERIALS AND METHODS
11 cases of flexion-type supracondylar fractures of the humerus(3 type I, 5 type II, 3 type III) were treated, 3 fractures(3 type I) with extension cast, 6 fractures(5 type II, 1 type III) with two lateral percutaneous K-wire fixation, 2 fractures(2 type III) with open reduction and crossed pin fixation. The K-wire were removed after 4-6 weeks of operation and the follow-up period ranged from 12 months to 26 months, averaging 18 months.
RESULTS
By Flynn 's functional and cosmetic criteria, nine cases were good and excellent results, one case (type III with two lateral percutaneous pin fixation) is fair result.
CONCLUSION
As the same methods of the extension-type supracondylar fractures, the K-wire fixation is useful method in the treatment of flexion-type supracondylar fractures of the humerus in children.

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Treatment of Displaced Supracondylar Fracture of the Humerus in Children -Open Reduction with Minimal Incision of the Manually Irreducible Fracture: Kyeong Jin Han, Soo Ik Awe, Eung Suck Park, Shin Young Khang; J Korean Soc Fract 2002;15(4):587-594. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.587

Abstract PDF

PURPOSE
We evaluated the results of the displaced supracondylar fractures in children treated by closed reduction and cast immobilization, closed reduction and crossed K-wires fixation or open reduction with minimal incision and crossed K-wires fixation.
MATERIALS AND METHOD
We retrospectively reviewed the results after 1 year of the treatment of 71 extension-type fractures (Gartland type II - 19 cases, type III - 52 cases) of supracondylar humeral fractures in children under age of 8 years. Closed reduction was impossible in 20 cases (1 type II, 19 type III) and we performed open reduction with minimal incision and cross percutaneous pinning. We measured Baumanns angle and range of motion of elbow and evaluated the results by Flynns criteria.
RESULT
By Flynns criteria, 91.5 % of satisfactory (excellent, good) results in cosmetic factor and 97.2 % in functional factor. The result of closed reduction and percutaneous pinning is more excellent in functional factor and that of the minimal open reduction and percutaneous pinning in cosmetic factor but over all satisfactory results were similar.
CONCLUSION
The treatment of the displaced supracondylar humeral fractures in children needs accurate and delicate reduction and firm fixation to prevent deformity and to preserve function of the elbow. Open reduction with minimal incision instead of general incision for the manually irreducible supracondylar humeral fractures would be a reliable and convenient method for the treatment of supracondylar humeral fractures in children.

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Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique
H.-Y. Lee, S.-J. Kim
The Journal of Bone and Joint Surgery. British volume.2007; 89-B(5): 646. CrossRef

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Double Tension Band Osteosynthesis in Supracondylar Fractures of the Humerus: Ho Jung Kang, Hong Hee Kim, Dong Joon Shim, Soo Bong Hahn, Eung Shick Kang; J Korean Soc Fract 2002;15(4):551-557. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.551

Abstract PDF: PURPOSE
This study evaluated the clinical result of supracondylar fractures of the humerus treated with double tension band osteosynthesis.
MATERIALS AND METHODS
From October 1992 to September 2001, 14 patients with supracondylar fractures of the humerus were treated by method of double tension band osteosynthesis. Eleven fractures were the results of slipped down injury and two traffic accidents and one direct trauma. All fractures were classified according to the AO fracture classification (A2; 2, A3; 1, C1; 6, C2; 3, C3; 2). There were 5 males and 9 females with average age of 51.6 years (range 15 to 88). Olecranon osteotomy was performed in 4 patients with severe comminuted fractures. Postoperative immobiliza-tions were required for an average of 20.6 days and consolidations were noted after an average of 10.1 weeks. Before operation, bone marrow density studies were performed in five fractures above 65 years. Average T-score of the patients were -3.65 on femur neck and -2.97 on lumbar spine. All patients were re-examined after an average of 16.4 months.
RESULTS
Union and consolidation was achieved in all 14 patients with no secondary displacement. In range of motion, eight patients judged their results as excellent and four as good. Ten patients had no pain and four had only occasional discomfort. Early removal of K-wires was performed in one patient because irritation of one side K-wires were develop. Sensory change of the ulnar nerve was noted in two patients. Anterior transposition of ulnar nerve was performed in one patient and the other was improved spontaneously. Skin necrosis was developed in one patient but was healed after pin removal and conservative care.
CONCLUSION
The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and more symmetrical compression than double plating. Therefore, in the commiuted osteoporotic fracture with poor tolerance for internal fixation with the plate or the simple supracondylar fractures in young age, double tension band osteosynthesis can provide sufficient and secure stability to allow early functional exercise.

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Operative Treatment for AO Type C Supracondylar Fractures of the Distal Femur: Ho Rim Choi, Joon Min Song, Hee Kwon, Youm Gyu Ko, Jang Geun Lee, Chang Hun Yoon; J Korean Soc Fract 2002;15(2):166-172. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.166

Abstract PDF

PURPOSE
Treatment of supracondylar fracture of the distal femur is challenging because of its characteristic anatomy and common occurrence of severe comminution. We evaluated the clinical results of 15 cases of AO type C supracondylar fracture.
MATERIALS AND METHODS
From December 1990 to November 1999, fifteen of 27 cases of AO type C supracondylar fracture of the distal femur were treated operatively. Mean follow-up period was one year and 5 months (range, 1 year-3 years and 3 months). The mean age of patients was 43.6 years. Eleven cases were treated by internal fixation and four cases by Ilizarov. Clinical results were evaluated by Schatzker and Lambert criteria.
RESULT
There were 5 excellent, 4 good, 1 fair and 1 poor results (81% satisfactory) in 11 cases treated by internal fixation and 1 excellent, 2 good, 1 fair results (75% satisfactory) in 4 cases treated by external fixation. COCLUSION: To get satisfactory results, AO type C supracondylar fracture of the distal femur need to be reduced anatomically and require rigid internal fixation. External fixation using Ilizarov can be an effective method of treatment in cases of open fracture and severe comminution with osteoporosis.

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Surgical Treatment of AO Type C Distal Femoral Fractures Using Locking Compression Plate (LCP-DF, Synthes®)
Kap-Jung Kim, Sang Ki Lee, Won-Sik Choy, Won-Cho Kwon, Do Hyun Lee
Journal of the Korean Fracture Society.2010; 23(1): 20. CrossRef

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Supracondylar Fracture of the Humerus in a Hemophiliac with Antibodies to Factor VIII - A Case Report: Duk Hwan Kho, Dong Heon Kim, Kyou Hyeun Kim, Sin Woo Lim; J Korean Soc Fract 2002;15(1):82-86. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.82

Abstract PDF: Fractures in hemophiliacs with antibodies to factor VIII are very rare, and the presence of antibodies to factor VIII in the patient`s blood makes antihemophilic replacement therapy and operative treatment extremely difficult. We treated one case of supracondylar fracture of the humerus in hemophiliac with antibodies to factor VIII surgically and present that case with a review of the literature.

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Treatment of Supracondylar Fracture of the Humerus in Children: by Immediate Closed Reduction & Lateral Percutaneous K-Wire Fixation: Byung Woo Ahn, Chong Kwan Kim, Jeong Hwan Kim, Chae Ik Chung, Jae Kyu Park, Young O Kim, Jong Ho Yoon; J Korean Soc Fract 2001;14(4):753-761. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.753

Abstract PDF: PURPOSE
To analyze children with displaced supracondylar fractures of the humerus that were treated by immediate closed reduction and then maintained by lateral percutaneous K-wire fixation.
MATERIALS AND METHODS
70 cases of supracondylar fractures of the humerus(5 type I, 19 type II, 46 type III) were treated, 14 fractures(5 type I, 7 type II, 2 type III) with cast, 49 fractures(12 type II, 37 type III) with lateral percutaneous pinning, 7 fractures(7 type III) with open reduction and internal fixation. The K-wire were removed after averaging 6.2 weeks of operation in out patient clinic. The follow-up period ranged from 6 months to 28 months, averaging 13 months.
RESULT
By Flynn's functional and cosmetic criteria, 47 fractures(95.9%) among 49 fractures, treated with immediate closed reduction and lateral percutaneous pinning, resulted in satisfactory criteria. Only one fracture was reoperated due to reduction loss.
CONCLUSION
Immediate closed reduction and lateral percutaneous K-wire fixation appears to be safe and reliable option for the treatment of supracondylar fractures of the humerus in children.

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Selective treatment for completely displaced supracondylar fractures of the humerus in children: Chang Wug Oh, Byung Chul Park, Young Woo Kim; J Korean Soc Fract 2001;14(3):534-540. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.534

Abstract PDF: PURPOSE
This retrospective study was performed to know the clinical results after closed reduction and open reduction for completely displaced supracondylar fractures of distal humerus in children.
MATERIALS AND METHODS
Twenty-eight cases of this injury at the mean age of 6.4 (range 21- 138 months), have been followed up over the minimum of one year. The types according to the position of displacement were 15 in posteromedial, and 13 in posterolateral displacement. There were 4 cases of associated nerve palsies (3;median, 1; radial). We tried the closed reduction (17 cases), but open reduction (11 cases) was indicated in irreducible cases with or without severe swelling. Then, the fractures were stabilized by percutaneous K-wires with lateral (23 cases) or cross pinning (5 cases). The differences of Baumann's angle, humero-ulnar angle, and elbow motion to uninjured side were calculated, and Flynn's criteria was used for evaluation.
RESULTS
All fractures were united without any infection or soft tissue compromise. The symptoms of injured nerve recovered within 8 weeks. According to Flynn's cirteria, results were excellent in eleven, good in 12, fair in 2, and poor in 3. The rates of satisfactory results over good were similiar between closed and open reduction, and the other factors including age and type of displacement were not meaningful. The mean Baumann's angle was 8.7 in closed and 6.6 in open reduction group. None of the patients showed restricted elbow motion above 10 degrees, even in 3 cases of hypertrophic scars in the group of open reduction.
CONCLUSION
The selective use of open reduction in completely displced supracondylar fractures of distal humerus in children, would show results as good as closed reduction.

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Supracondylar Intramedullary Nail for Femoral Supracondylar Fracture following TKA: 3 Cases Report: Jun Dong Chang, Hyun Min Han, Suck Woo Kim, Won Ik Lee, Soo Joong Choi, Chang Ju Lee; J Korean Soc Fract 2000;13(4):891-896. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.891

Abstract PDF: A periprosthetic supracondylar femoral fracture is one of the complications of the total knee arthroplasty(TKA). The periprosthetic supracondylar femoral fracture after TKA occurs approximately 0.3% to 2.5% and various methods have been introduced to treat this fracture. We report three cases of supracondylar femoral fractures following TKA, with brief review of pertinent literatures, in which retrograde supracondylar intramedullary nail provided satisfactory results. In severe osteoporotic patient, firm fixation of the nail was obtained by using cement and early motion of the knee joint was possible. In addition, we found that the supracondylar intramedullary nail could be used without insertion difficulty in all PCL retaining TKA systems which were available in use in our country.

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Treatment of Displaced Flexion Type Supracondylar Fractures of the Humerus in Children: Comparison with Extension Type: Jong Sup Shim, Min Wook Jung; J Korean Soc Fract 2000;13(4):1044-1052. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1044

Abstract PDF: PURPOSE
We tried to compare the clinical and the radiologic features between the extension and the flexion type of supracondylar fractures of the humerus in children. MATERIAL AND METHODS: Between May 1995 to September 1999, 68 extension type and 7 flexion type fractures were treated surgically. Baumann's angle, humeroulnar angle, carrying angle, clinical result and clinical features were analyzed and the flexion types were compared with the extension types. Changes in Baumann's angle, humeroulnar angle and carrying angle were evaluated as Excellent or Good, Fair, Poor with reference to the opposite elbow by Kallio method. The Clinical results were evaluated as Excellent or Good, Fair, Poor by the modifying Kallio method.
RESULTS
Mean changes in Baumann's angle were 4.6degrees , 9.3degrees and those in the humeroulnar angle were 3.8degrees , 8.0degrees ( respectively in extension and flexion type (P=0.047, P=0.021, respectively). Changes in carrying angle were Excellent or Good( <10degrees ), Fair(10 ~15degrees ), Poor(> or =15degrees ) in 65, 1, 2 children in extension type and 3, 4, 0 children in flexion type, respectively. Clinical results were Excellent or Good, Fair, Poor in 59, 6, 3 children in extension type and 3, 4, 0 children in flexion type, respectively (P=0.002).
CONCLUSION
Changes of Baumann's angle and carrying angle in flexion type of supracondylar fractures of the humerus in children were greater than those in extension type. The clinical results were poorer in flexion type. We suggested that treatment for flexion type supracondylar fractures should be careful and meticulous with frequent radiologic checkups and follow-ups. Also, if a reduction is not satisfactory with closed method, open reduction should not be hesitated.

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Two stage Operative Treatment of Supracondylar Open Comminuted Fracture of Femur: Temporary fixation with Transarticular Ender nails: Song Lee, Dong Ki Ahn, Seung Hwan Kim, Sung Wook Chun; J Korean Soc Fract 2000;13(3):470-478. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.470

Abstract PDF: PURPOSE
In many cases of open comminuted supracondylar fracture, it is very hard to apply traditional methods. So we have used Ender nails for temporary transarticular fixation. We thought that it could provide enough stability to control the wound and didn't promote further soft tissue damage or infection. We performed 2nd stage rigid fixation and bone graft after soft tissue healing. We have studied to prove this staged operation valuable to treat the very severe open comminuted supracondylar fracture of femur.
MATERIALS AND METHODS
We analysed 16 cases which have been treated with such staged operation method from April 1992 to April 1996 about complication, union time and functional result in retrospective method.
RESULTS
We could prevent severe wound infection in all cases. We performed 2nd stage rigid fixation and bone graft average 6 weeks after first stage temporary fixation. The average union time was 8 months and average range of motion was 10degrees flexion contracture and 100degrees further flexion.
CONCLUSION
In patients with very severe open comminuted supracondylar fracture of femur, the temporary fixation with transarticular Ender nails allowed the successful initial management for the secondary rigid fixation and bone graft and time could be saved for management of concomitant injuries. So this new staged operation is considered as a good method for safety, union time and functional result.

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Clinical Study of Pin Fixation of Suprecondylar Fracture of the Humerus in Children: Jun Kwang Park, Tae Hyun Yoon, Young Lae Moon, Kwang Kim; J Korean Soc Fract 2000;13(2):208-215. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.208

Abstract PDF: PURPOSE
: The supracondylar fracture of the humerus is the most common elbow injury in children. They are commonly treated with closed reduction and percutaneous pin fixation. We measured the stability of supracondylar fractures, fixed with different configuration of pins, according to the each type of supracondylar fractures. MATERIAL AND METHOD : We reviewed 42 supracondylar fractures of the humerus in children that were treated with percutaneous pon fixtion from 1988 to 1997. The follow up period ranged from 1.5 to 41 months. The patient's average age was 9.2 years. The most common cause of injury was fall down injury in thirty three. The extension type is the most common, accounting for 95% of cases. We compared the initial post-op films with the follow up films which was checked at 2-3weeks later to establilish the stability by assessing the anterior beak prominence of the proximal fragment on lateral radiograph.
RESULT
: There were 8 cases of Type II-A (hyperextension post cortext intact AP, lateral appearance), 10 cases of Typer II-B (displaced/ angulated with osseous contact AP, lateral appearance) and 24cases of Type III(completely displaced AP, lateral appearance). The greatest stability was achieved with two crossed pons placed from the medial and lateral condyles. Final failure of the fixation occurred in two cases of the group II-B, fixed with only two lateral pins.
CONCLUSION
: The two crossed pins which were placed from the medial and lateral condyles provided the greatest stability of the fracture fragment. When we treat the type II-B pattern fracture (displaced/ angulated with osseous contact AP, lateral appearance), we must check the rotational stability after lateral pin fixation. If the fracture is unstable, we must fix the fracture with additional medial crossed pin fixation.

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Neurologic recovery of neural injuries associated with supracondylar fractures of the humerus in children: Hyung Ku Yoon, Seoung Ju Jeon, Ho Seung Jun, Kye Nam Cho, Chul Won Kang; J Korean Soc Fract 2000;13(1):158-165. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.158

Abstract PDF: PURPOSE
: The purpose of our study in to determine the incidence of spontaneous recovery from neural injuries associated with supracondylar fractures of the humerus and to assess the results of electromyographic study and nerve conduction velocity. Material & methods : The 160 displaced supracondylar fractures of the humerus which had operation at the Sung Ae general hospital between April 1994 and 1998 were reviewed. Twelve(7.5%) were associated with complete neural injuries involving 16 nerves ; 9 radial, 5 ulnar and 2 median nerves. The mean age was 7.8 years old and boys outnumbered girls by 9 to 3. The follow-up period ranged from 1 year to 5 yeras 2 months. 11 fractures were managed with closed reduction and one with open means. All of the neural injuries were initially managed only by closed observation. At recent follow-up examination, we assessed the motor and sensory neurological status with Seddon's modification, grip strength and two-point discrimination in the autonomous zone. Electromyography(EMG) and nerve conduction velocity(NCV) were performed in 13 nerves of 10 patients who were assessed as complete recovered clinically.
Result
: Spontaneous neurological recovery occurred in 11 patients(15 nerves) at a mean of 2.4 months(range, 2 to 3.5 months.) Clinically, these nerves were assessed as normal. In the EMG and NCVs, 4 of 13 nerves resulted in adnormal findings. 2 radial and 1 ulnar nerve showed mild sensory neuropathy and 1 ulnar nerve showed mild denervation potentials in EMG and slow motor and sensory NCVs.
CONCLUSION
: We think that neural injuries associated with the displaced supracondylar fractures of the humerus tend towards spontaneous recovery within 4 months. And even though the neurologic recoveries are clinically complete, these are not always completely recovered in electromyographic study and nerve conduction velocity.

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Treatment of Supracondylar Fractures of the Humerus in Children by Open Reduction: Jung Ryul Kim, Jun Mo Lee, Joo Hong Lee, Pil Soo Sin; J Korean Soc Fract 1999;12(4):1040-1045. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1040

Abstract PDF: PURPOSE
To analyze the results of open reduction in displaced supracondylar fractures of the humerus in children, and to propose guidelines for an open approach to supracondylar fractures.
MATERIALS AND METHODS
Twenty-six children(average age 6.7 years), who had open reduction of severely displaced supracondylar fractures were reviewes retrospectively over a 2- year period(1993 to 1997). Elbow range of motion, carrying angle, and radiographic measurement of the Baumann angle were assessed, then each distal humerus were compared to uninjured side.
RESULTS
At follow-up, the Baumann angle and carrying angle differed by an average of 2 degrees and 4 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 96% of patientl, and there wah no significant cubitus varus.
CONCLUSIONS
Open reduction of severely displaced supracondylar fractures is a safe and effective procedure, for which orthopedists should lower their threshold, given certain appropriate indicators.

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Ulnar nerve palsy After Percutaneous Pinning in Childrens Supracondylar fracture: Tai Seung Kim, Jay Rim Choi, Kuhn Sung Whang; J Korean Soc Fract 1999;12(3):674-678. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.674

Abstract PDF: Many authors have described percutaneous pinning techniques as the treatment of choice for most supracondylar fractures. But little information is available concerning ulnar nerve injury resulting from pinning techniques. When the surgeon is faced with a postoperative ulnar nerve palsy, it can be the result of unrecognized preoperative palsy, manipulation during surgery, or damage to the nerve by one of the medial pin placements. The options for management include exploration, medial pin removal, or observation. We reviewed our hospital records on the 132 supracondylar elbow fractures that we treated in children from 1991 to 1998 There were 16 palsies found with normal preoperative and abnormal postoperative ulnar nerve function. Normal nerve function returned without exploration and early medial pin removal in all cases. We recommand that observation is the appropriate way to manage these postoperative ulnar nerve palsies in most cases.

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Assessments of Reduction for Supracondylar Humerus fractures in Children: Comparison of Clinical carrying angle, Baumanns angle and Metaphyseal-diaphyseal angle: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Seong Hwan Kim; J Korean Soc Fract 1999;12(3):660-666. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.660

Abstract PDF

PURPOSE
The object of this retrospective study is to verify Baumanns angle as assessment methods of reduction for supracondylar fracture of the humerus in children and to confirm what is the more accurate assessment methods of supracondylar fracture of the humerus between Baumanns and metaphyseal-diaplyseal angle.
MATERIALS AND METHODS
34 cases of more than 1 years follow up after closed reduction and pinning were reviewed. Simple linear regression has been used for statistical analysis and Pearsons correlation coefficient(rho) has been used for comparison of Baumanns angle and metaphy seal-diaphyseat angle.
RESULTS
The results form simple linear regression, about a 10 change in Baumanns angle contributes to a change in the carrying angle of approximately 3.7 on the uninjured(=-0.372, r=-0.750, P<0.001) and injured( =-0.365, r=-0.759, P<0.001) arms. In comparison of Baumanns angle and metaphyseal-diaphyseal angle to predict final carrying angle, the correlation coefficient between Baumanns angle and carrying angle(r=-0.759) was higher than that between metaphyseal-diaphyseal angle and carying angle(r=-0.495) with statistical significant using Fishers rho(P<0.05).
CONCLUSION
The Baumannss angle after reduction can be reliably used to predict accurately the final carrying angle and is more accurate than the metaphyseal-diaphyseal angle to predict the final carrying angle.

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture
Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park
Journal of the Korean Fracture Society.2010; 23(1): 90. CrossRef

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Treatment of comminuted supracondylar fractures of the femur using Ilizarov method: Myung Chul Yoo, Yoon Je Cho, Ki Tack Kim, Young Soo Chun, Na Sil Pyo, Sung Gun Kim; J Korean Soc Fract 1999;12(3):529-537. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.529

Abstract PDF: PURPOSE
To evaluate the effectiveness of the Ilizarov method as a treatment of open or comminuted supracondylar fractures which are uncommon, and difficult to manage because of the wide range of potential complications.
MATERIALS and METHODS
Between 1992 and 1999, we treated open or comminuted supracondylar fractures of the femur by Ilizarov method in whole period or conversion to OR/IF with or without bone graft after transient Ilizarov fixation. There were 13 cases in 11 patients. Open comminuted fractures were seven cases and closed comminuted fracutres were six cases. We compared Ilizarov method in all procedures and temporary mode followed by internal fixation for definite care.
RESULTS
According to Schatzker and Lamberts assessment the results were good or excellent in ten cases(77%). And the results were rated as good or excellent in 67% of case of Ilizarov method in all procedures, and 86% of cases changed to OR/IF.
CONCLUSION
Ilizarov technique is an useful method in cases of open and/or comminuted supracondylar fractures of the femur. And after initial stabilization of fracture, conversion to OR/IF is advisable to prevent pin site infection and allow ROM excercise of the knee joint.

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Management of Displaced-Extension Type Supracondylar Fractures of Humerus in Children: Suk Myun Ko, Myung Ku Kim, Kyoung Ho Moon, Ryuh Sup Kim, Kyu Jung Cho, Dong Hun Choi; J Korean Soc Fract 1999;12(2):351-360. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.351

Abstract PDF: From June 1996 to February 1998, we reviewed the cases of 27 patients who had a displaced - extension type supracondylar fracture of the humerus retrospectively. The mean length of follow-up was 1.3 years. According to Gartland classification, type II was 7 cases (26%), type III-A was 11 cases (41%), type III-B was 9 cases (33%). We treated with three different methods, including closed reduction and percutaneous Kirschner-wire fixation, skeletal traction, and cast application after closed reduction. In type II fractures, we used two parallel lateral pins. In type III fractures, we used 2 lateral parallel pins followed by 1 medial crossed pin predominantly. The results of treatment were assessed using the criteria of Flynn et al. We graded cosmetic and functional factors separately. Satisfactory results were achieved by percutaneous K-wire fixation(96%). There were seven neural lesions. These were the result of injury and not of the treatment, with exception of one case. Neural injuries spontaneously resolved at a mean of 2.5 months(range 1.5 to 5 months) after injury. Varus deformity was present in one patient. There was no Volkman's ischemic contracture. Percutaneous Kirschnerwire fixation is advocated as the method of choice for the majority of displaced-extension type supracondylar humerus fractures in children.

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The Results of the Percutaneous K-wire Fixation for the Supracondylar Fractures of the Humerus in Children: Chil Soo Kwon, Jong Kuk Ahn, Byung Hyun Jeong, Jin Chung, Ho Cheol Rhee; J Korean Soc Fract 1999;12(1):187-193. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.187

Abstract PDF: The cases of 160 patients who had a displaced supracondylar fracture of the humerus were reviewed retrospectively. According to the Flynn's criteria, the results of treatment were excellent 33%, good 53%, fair 10%, poor 4%. No neurovascular complication was appeared. In two cases, cubitus varus deformity was appeared to be related with incorrect reduction. We believe that percutaneous k-wire fixation is excellent method in treatment of the displaced supracondylar fractures in children. There was no significant difference of clinical results among methods of percutaneous K-wire fixation but lateral 2 and medial 1 cross pinning has advantages : easy technique in insertion of lateral 2 pins, biomechanical stability and removal of medial pin in the irritation of ulna nerve without significant influence of stability.

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Treatment of Supracondylar Fractures of the Humerus in Children: Duk Yong Lee, Jae Ik Shim, Taek Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yoen Sik Yu, Young Jin Park; J Korean Soc Fract 1999;12(1):179-186. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.179

Abstract PDF

The supracondylar fracture of the humerus is the most common fracture of the elbow in children and is occasionally associated with significant residual complications such as cubitus varus deformity. Clincal analysis was performed on 32 patients with displaced supracondylar fractures of humerus, who were treated either by closed reduction and percutaneous pinning or by open reduction and internal fixation. The results were as follows : 1. The average age of the children was 6.8 years old in both sexes, and male to female was 21 : 11. 2. The extension type was 26 cases(82%), flexion type was 6 cases(18%) and the left side was more frequently involved. 3. According to Pirone classification, type II was 14 cases, type III 18 cases. 4. There was no significant difference in the mean duration of bony union between the percutaneous group and the open reduction group. 5. Cubitus varus deformity and limitation of elbow motion were more common complications in open reduction group.

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Citations to this article as recorded by

The Effect of Rotational Deformities on Cubitus Varus for Supracondylar Humerus Fractures in Children
Hyun Dae Shin, Kyung Cheon Kim, Dong Kyu Kim, Woo Yong Lee
Journal of the Korean Orthopaedic Association.2010; 45(5): 373. CrossRef

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