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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Treatment for the Supracondylar Fractures of the Distal Humerus with Cannulated Screw: Jin Soo Park, Young Khee Chung, Jung Han Yoo, Kyu Cheol Noh, Kook Jin Chung, Dong Nyoung Lee; J Korean Fract Soc 2007;20(1):58-63. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.58

Abstract PDF: PURPOSE
To evaluate the results of the treatment of the supracondylar fractures of the humerus according to the fixation methods with cannulated screw.
MATERIALS AND METHODS
Eight patients, aged 49 to 82 years (average, 65 years), were reviewed after a mean follow-up of 16 months (range, 12~24 months). According to AO classification all fractures were classified as type A2 (simple transverse supracondylar fracture). All patients underwent closed reduction. Percutaneous fixation with cannulated screws was performed in 8 patients. Three of 8 patients had associated medical problems and one patient had distal radius fracture. The functional results were assessed by the Mayo Elbow Performance Score.
RESULTS
Mean operation time was 59 minutes (45~75) and all the patients with cannulated screw fixation had bony union and were able to early ROM exercise. Mean ranges of motion was 5~120 degrees with excellent functional results. Functional evaluation of elbow joint by Mayo method showed mean value of 88 (75~95).
CONCLUSION
The cannulated screw fixation of supracondylar fracture of humerus, especially in the elderly aged group with medical disease had excellent functional results (rigid fixation & early ROM exercise) due to shortening of surgery time and anesthesic time, combined with decreased technical difficulties of the surgical procedure

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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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Treatment of Supracondylar-Intercondylar Femoral Fractures with a Retrograde Intramedullary Nailing: Phil Hyun Chung, Chung Soo Hwang, Suk Kang, Jong Pil Kim, Yong Jin Jeon; J Korean Fract Soc 2004;17(2):110-116. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.110

Abstract PDF

PURPOSE
We analyzed the cases of supracondylar-intercondylar femoral fracture treated with retrograde intramedullary nail and report the clinical results and its usefulness.
MATERIALS AND METHODS
We reviewed 17 cases of supracondylar-intercondylar femoral fracture that had been treated with retrograde intramedullary nail and each of patients had been followed up for a minimum one year. Post-operative functional assessment was performed using a scale developed by Sanders et al. The evaluation scale assesses range of motion, pain, walking ability, return to work, and alignment and shortening as measured on radiograph.
RESULTS
According to functional assessment of Sanders et al, there were 6 excellent, 9 good, 1 fair, and 1 poor results, that is, 94% showed above excellent results. Bony union was obtained in average 5 months after operation. The post-operative complications were varus deformity in 1 case, wound infection in 1 case, stiffness of knee joint in 1 case, and metal failure in 1 case.
CONCLUSION
The treatment of supracondylar-intercondylar femoral fracture with retrograde intramedullary nail is one of the good surgical options for clinically preferable results with the advantages in early joint motion and early ambulation.

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Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part
Jong-Ho Yoon, Byung-Woo Ahn, Chong-Kwan Kim, Jin-Woo Jin, Ji-Hoon Lee, Hyun-Ku Cho, Joo-Hyun Lee
Journal of the Korean Fracture Society.2009; 22(3): 145. CrossRef

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Treatment of Completely Displaced Supracondylar Fracture of Humerus in Children: Bu Hwan Kim, Mu Jung Heo, Won Jun Hwang; J Korean Soc Fract 2003;16(4):585-591. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.585

Abstract PDF

PURPOSE
We performed a retrospective study of completely displaced supracondylar fracture of humerus in children to evaluate the result of primary open reduction and internal fixation for this injuries, and also to know whether it is recommendable or not for such injuries.
MATERIALS AND METHODS
For 5 years duration from March '96 to Feb. '01, we treated 58 cases of completely displaced supracondylar fractures of humerus in children. Among them we performed primary open reduction and internal fixation of this fracture in 14 cases. We followed up those cases more than 18 months and evaluated the results by Flynn et al. and Mark et al. criteria.
RESULTS
Eleven of them resulted in excellent grading by both Flynn and Mark criteria. Three cases not involved in excellent grading proved to be good result by Mark criteria. But by Flynn criteria, 2 cases showed good results and the other one proved to be fair. In all cases, the patient and parents were satisfied cosmetically and functionally. Only in one case, the recorded grading was different, fair by Flynn and good by Mark criteria.
CONCLUSION
Primary open reduction and internal fixation in the treatment of completely displaced and not easily reduced supracondylar fracture of humerus in children resulted excellent and good results with few complications, and patients were satisfied with the results functionally and cosmetically. So we recommend proceeding to primary open treatment and internal fixation for these difficult fractures with low threshold to open reduction.

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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 Nonunion in Femoral Supracondylar and Intercondylar Fracture: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yeon Sik Yu, Eun No Lee, Yoon Yeup Kim; J Korean Soc Fract 1999;12(4):844-850. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.844

Abstract PDF: The femoral supracondylar and intercondylar fractures are difficult to be treated due to severe soft tissue damage, comminution, intraarticular extension of fracture and injury to the quadriceps mechanism frequently. The causes of nonunion are inadequate anatomical reduction, fixation failure, bone defect and infection occasionally, which is difficult to be treated. The authors analyzed 16 cases with nonunion of femoral supracondylar and intercondylar fracture who had been treated surgicdlly from January 1990 to December 1991 According to AO/ASIF classification in the initial fracture patterns, type A were 8 cases, type B was 1 case and type C were 7 cases. The duration between initial treatment and surgical treatment of nonunion was 6 months in average. The causes of nonunion were fixation failure due to inadequate device selection in 9 cases, inadequate anatomical reduction or surgical technique in 4 cases and infection in 3 cases. The treatmentt were internal fixation with Dynamic condylar screw(DCS) in 9 cases, internal fixation with condylar blade plate in 4 cases, monofocal lenghtening with Ilizarov in 1 case and bifocal lenghtening with Ilizarov in 2 cases. According to Schatzker classification, the good result was obtained in 11 cases(68.8%). The complications were 3 knee joint ankyloses, 2 superficial wound infections, 1 delayed union and 1 deep vein thrombosis. In conclusion, the requirement for the good result in treatment of nonunion are exact anatomical reduction, rigid fixation and autogenous bone graft.

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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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Treatment of Comminuted Supracondylar and Intercondylar Femoral Fractures with AO Dynamic Condylar Screw: Kyung Chul Kim, Jae Yeul Choi, Hwa jae Jeong, Bon Seep Koo, Kyung Ho Kim; J Korean Soc Fract 1999;12(2):253-258. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.253

Abstract PDF: Between 1990 and 1995, 22 comminuted supracondylar and intercondylar femoral fractures in 22 patients were treated with the AO dynamic condylar screw(DCS). Minimum twelve months of clinical and radiographic follow-up evaluation were available on all patients. All cases achieved clinical and radiographic bony union. Functional results were graded using a Schatzker and Lambert's criteria. Results were seen to be excellent to good to fair in 100% of A2 cases, 86% of C2 cases, 75% of A3 cases and 67% of C3 cases. The more comminuted fractures were found to have worse clinical results and more radiographic malunion. The ability to obtain good fixation in osteoporotic bone is distinct advantage of the DCS. The results of DCS fixation compare favorably with previous studies using other fixation devices in comminuted supracondylar and intercondylar femoral fractures

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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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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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Results of cross pinning fixation for supracondylar fracture of the humerus in children: considering adequate reduction and instability: Jong Hun Jee, Bong Soon Chang, Seung Baik Kang, Choong Hee Won, Eui Seong Choi; J Korean Soc Fract 1998;11(4):985-993. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.985

Abstract PDF: The supracondylar fracture of the humerus is the most common fracture of the elbow in children. New trends of treatment is that if satisfactory reduction is achieved by manual reduction, medial and lateral cross percutaneous pin fixation is better than others for stable fixation. Among many complications, cubitus varus deformity most commonly results from inaccurate reduction and failure in maintenance of fixation. The obliquity of the fracture, together with internal rotation, causes angular deformity. The angulation and coronal rotation, or tilting of distal fragment, often cause the deformity and limitation of motion of elbow. The porty-two Gartland type II, III supracondylar fractures of the humerus were treated by losed reduction or open reduction with percutaneous pinning or internal fixation from May 1993 to December 1995. The results were as follows; 1. the frequency of difference above 5degree in Baumann's angle was relatively high if fracture line is oblique on lateral roentgenogram or medial column comminution is present, that means unstable reduction. 2. In average, 2.7 pins were needed for reduction and maintenance of stability at this time. 3. Even though a few degree of rotation(5mm), translation(2-4mm) and angulation(5-10degree) were present at immediate reduction, carrying angle and Baumann's angle of follow-up period were often remained about the similar values compared with healthy side. If acceptable intraoperative carrying angle was achieved and a few degree of rotation, translation and angulation were permitted after reduction, varus deformity and limitation of motion of elbow were rerely caused. so repeating forceful manual reduction for anatomical reduction must be avoided because the final results may become progressively remodelled to normal.

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The Comparative Sturdy of Treatment between the Skeletal Traction and the Operation of the Supracondylar Fracture in Children: Eu Sub Chung, Young Kee Lee, Byoung Ho Lee; J Korean Soc Fract 1998;11(4):970-976. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.970

Abstract PDF: The most common fracture about the elbow joint in children is supracondylar fracture. That treatment has many fitsfalls and had writtened about its method and the prevention of serious complication such as Volkmann ischemic contractre and cubitus varus deformity. the authors analyzed the follow-up results of 58 cases of supracondylar fractures treated by skeletal traction, percutaneous pinning and open reductionin Persbyterian Medical Center from March 1992 to November 1996. The average follow-up was 20 months(12-54 months). The results were as follows. 1. The mean age was 7.8 years, ranged from 1 year to 15 years, and the male and the female ratio was 1.9:1. 2. Seventeen cases were treated with skeletal traction group, thirty cases with closed reduction and percutaneous pinning group, eleven cases with open reduction and internal fixation group. 3. The average duration of admission in skeletal traction group was 23.5 days, 5.2 days in percutaneous pinning group and 14.7 days in open reduction and internal fixation group. 4. The ration of hospital cost to that in the skeletal group were 0.85+/-0.18 in the percutneous pinning group, and 1.43+/-0.21 in the open reduction and internal fixation group. 5. According to the Mitchell and Adams' criteria, the results of skeletal tracion group were excellent in 58.8%, good in 35.3% and poor in 5.9%; the results of percutaneous pinning group were excellent in 60%, good in 36.7% and poor in 3.3% ; and those of open reduction group were excellent in 54.5%, good in 27.3% and poor in 18.2%, respectively, on mean follow-up of 1 year and 8 month. So, our result indicated that the closed reducion and percutaneous pinning is a simple and cost-effective method for treatment of supracondylar fractures of the humerus in children, but some instances, the skeletal traction might be another treatment method in supracondylar fractures.

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Treatment of Supracondylar Fracture of the Femur using the Supracondylar intramedullary Nail under the Arthroscopy(Preliminary Report): Suk Woong Yoon, Dong Ha Kang, Tae Sung Hwang, Jeong Il An; J Korean Soc Fract 1998;11(4):778-783. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.778

Abstract PDF: Supracondylar nailing is one of the treatment methods for supracondylar fractures of the femur but it needs arthrotomy. We introduce a mew technique of supracondylar nailing under the arthroscopy without arthrotomy. It is closed reduction and intramedullary supracondylar nailing under the arthroscopic control. The potential benefits of this method are decreased unnecessary soft tissue dissection, excellent intraarticular visualization and reduction, decreased blood loss and shortened operative time and postoperative rcovery. We performed this new technique on 4 cases of supracondylar fractures of the femur. Theresults were as follows; 1. Among the 4 cases, 3 cases were AO type A and 1 case was AO type C. 2. All cases showed bony union and average range of knee motion was 110 degrees. 3. The operation time ranged from 60 minutes to 170 minutes and averaging 110 minutes.

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Treatment of Supracondylar Fracture of the Humerus in Children: by Early Closed reduction & K-Wire Fixation: Jong Sup Shim, Won Hwan Oh; J Korean Soc Fract 1998;11(3):634-643. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.634

Abstract PDF: We treated supracondylar fracture of the humerus in children by early closed reduction and K-wires fixation using two lateral parallel K-wires for partially displaced fractures(Gartland Ib, II) and three K-wires,two lateral and one additional medial crossed K-wire for type III fractures. This study is to analyze our method for the treatment of supracondylar fracture of the humerus in children. Sixty-two fractures(4 type Ib, 20 type II and 38 type III) underwent K-wires fixation after closed reduction of the fracture from October 1994 to April 1997 were included in this study. The patients age ranged from 2 years and 2 months to 12 years and 7 months, averaging 6 years and 2 months. All the fractures were treated within 24 hours after arrival in the hospital. After general anesthesia, each fracture was reduced manually and fixed by K-wires under fluoroscopic control. Two lateral parallel K-wire were used for fixation of all type Ib and II fractures. We tried to keep the gap between two K-wires be 1 cm or more. In type III fractures, fractures were fixed by two parallel lateral K-wires and followed by one medial crossed K-wire. The K-wires were removed after averaging 3.2 weeks after operation in out patient clinic. The follow-up period ranged from 6 months to 34 months. averaging 14 months. By Flynn's functional and cosmetic criteria, 37 fractures (97.4%) among 38 type III fractures resulted in satisfactory criteria. All of the type I and II fractures (100%) resulted in satisfactory criteria. In conclusion, our decision is considered as safe and reliable option for the treatment of supracondylar fractures of the humrus in children.

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Treatment of the Supracondylar and Intercondylar Fracture of the Humerus in Adults: Sang Won Park, Young Soo Byun, Ki Hoon Kang, Sang Won Han; J Korean Soc Fract 1998;11(2):378-383. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.378

Abstract PDF: Supracondylar and intercondylar fracture of the adult humerus is uncommon and present a difficult management problem. The purpose of this study is to analyse the clinical results according to types of the fracture and methods of the treatment. The authors reviewed twenty-eight patients treated for supracondylar and intercondlar fracture of the adult humerus at the Department of Orthopaedic Surgery, Korea University Hospital from January 1990 to August 1996. The mean follow up period was 41 months (12months to 79months). The results were as follows: 1. According to AO classification, there were 9 cases(32%) of Type A, and 19 cases(68%) of Type C. 2. The Methods of treatment were closed reduction and cast immobilization in 4 cases, closed reduction and fixation with K-wire or screw in 11 cases, open reduction and fixation with K-wire or screw in 7 cases and open reduction and plate fixation in 6 cases. 3. Poor results can be expected after closed reduction and cast immobilization, open fracture, above 60 years old, and Type C according to AO classification.

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Treatment of Supracondylar Fractures of the Humerus in Children: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Eu Suk Lew, Tae Hoon Kim; J Korean Soc Fract 1997;10(4):964-971. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.964

Abstract PDF: Supracondylar fracture of the humerus is the most common elbow fracture in children. It can be complicated by Volkmanns ischemic contracture, nerve injury, deformity of elbow, joint stiffness, and myositis ossificans, etc. even after the treatment. Various methods of treating displaced supracondylar rracture have been described, and the indications for open reduction and internal fixation are relatively established well. The surgeon, however, might be in trouble with making decision for closed reduction, whether to maintain by casting or by percutaneous pinning. From fan. 1990 to May 1990, 117 patients of supracondylar tracture had been treated in Seoul Adventist Hospital, and 82 patients of them were challenged initially by closed reduction and casting. Among them, 51 cases have been followed more than 1 year, and they are reviewed. 1. The average age was 7.2 years, and the patient population consisted of 33 boys and 18 girls. 2. 3 cases of nerve injuries, 2 cases of ipsilateral forearm bone fractures, 2 cases of impending Volkmanns ischemic contracture and 1 case of cerebral contusion were associated with supracondylar fracture. 3. Fracture pattern were classified as flexion type of 1 case and extension type of 50 cases. According to Gartland classification, type II was 16 cases(31.4%), type III-A was 27(52.9%) and III-B was 7(13.7%). Of all, 28 cases(54.9%) were comminuted and 23 were non-comminuted. On the other hand, 14 cases(27.5%) were oblique fracture and 37(72.5%) were transverse one, classified by pattern of fracture line. 4. Success rate of closed reduction and casting were 56.3% in Garland type II, 33.3% in type III-A, 42.9% in type III-B. In comminuted fracture, it was 21.4% and 65.2% in non-comminuted one. Success rate was 7.1% in oblique fracture, and 54.1% in transverse one. This suggests that comminuted fracture or oblique fracture should not be tried by closed reduction and casting but by percutaneous pinning. 87.5% of non-comminuted and transverse fractures were treated successfully by initial closed reduction and casting, and it also suggests that closed reduction and casting should be done only in this case selectively. 5. By Flynns criteria the results were excellent in 9 cases, good in 8, fair in 3 and poor in 1 with casting. Percutaneous pinning resulted in 15 excellent, 10 good, and 1 fair cases. Open reduction and internal fixation resulted in 2 excellent and 2 good cases.

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A Study of the Treatments and the Measurements of Carrying Angle on the Supracondylar Fracture of the Humerus in Children: Young Sun Song, Sang Hyeon Yun; J Korean Soc Fract 1997;10(4):956-963. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.956

Abstract PDF

Supracondylar fracture of the humerus is the most common elbow injury in children and adolescents, and it also has many considerable complications. Especially, cubitus varus deformity out of the complications is very unsatisfactory result to the patient in recovery periods in functional and cosmetic viewpoints. Not only nearly or perfect anatomic reduction but aiso accurate measurement of varying angle at the fracture site were necessary to minimize this potential problems. Therefore, the author measured the angles of 250 patients elbow X-ray using Trochlea-Capitellum angle method, a new method of radiological assessment for comparison to carrying angle & Baumanns angle methods. And it appears that this method has statistically less error risk and to be easy to measure angle on X-ray films. Next, the author reports the excellent results of K-wire percutaneous fixation treatment compare to open reduction and internal fixation with statistical siginficance. From the authors retrospective clinical & radiological study of 250 supracondylar fractures, the following results were obtained. 1. Mean differences of the angle between the normal & injured arm were 7.25 in carrying angle, 5.07 in Baumanns angle, and 3.97 in Trochlear-Capitellum angle. 2. K-wire percutaneous fixation group patients stayed in the hospital only average 3.3 days, shorter than average 8.9 days open reduction and internal fixation group. 3. T-test of T-C angles between the K-wire percutaneous fixation and open reduction & internal fixation group show no significant difference. Therefore the former treatment is recommandable. 4. According to the Flynns evaluation, the results of K-wire percutaneous fixation treatment were Excellent in 87 cases(69.1%), Good in 28 cases(22.2%), and Fair in 11 cases(8.7%).

Citations

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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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Causative Factor for Cubitus Varus Deformity in Severely Displaced Supracondylar Fractures of the Humerus in Children : s Rotational Deformity of Distal Fragment Needed to be Acurately Reduced?: Seung Woo Suh, Jeong Ho Park, Jong Gun Oh, Seung Ju Chun, Jeong Ro Yoon, Seok Hyun Lee; J Korean Soc Fract 1997;10(3):712-717. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.712

Abstract PDF: We reviewed retrospectively 53 cases of supracondylar fracture of humerus in children which were severely displaced(Gartland type III). All patients were treated with closed reduction and percutaneous pinning. Purpose of this study is to evaluate the residual effect of incompletely reduced fragment, especially of rotation of distal fragment(represented by fish-tail sign) on clinical relults. The quality of reduction was determined by carrying angle, varus tilting, existence of fish-tail sign and medial displacement. Of the 53 elbows, fish tail signs only presented in twelve cases(50.0%), medial tilting combined with fish tail in five(20.8%) and medial displacements in seven cases(29.2%). Final results by Flynn et al. were as follows; Excellent was in 40 cases(15.9%), Good in 6(11.3%), Fair in 1(1.8%), poor in 6(11.3%). Six cases of poor outcomes resulted from cubitus varus deformed elbow, of which cubitus varus deformity developed in 5 cases of medial tilted distal fragment, one developed in medially displaced fragment, and cases presented with fish tail sign(rotation of distal fragment) had no contribution to cubitus varus deformity yielding acceptable clinical results. In conclusion, even though the quantification of fish tail sign is needed, fish tail sign only presenting on fluorscopy might be acceptable in operative room.

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Treatment of Cubitus Varus Using Tension Band Wiring after the Supracondylar Osteotomy: Dne Yong Han, Hui Wan Park, Dong Eun Shin, Ki Won Suh; J Korean Soc Fract 1997;10(3):678-684. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.678

Abstract PDF

Cubitus varus is the most common angular deformity that results from supracondylar fractures in children. Although this deformity rarely limit elbow function, the correction is frequently requested due to cosmetic problem. This paper was prepared to describe the operative method and to evaluate the clinical results of tension band wirinB after distal humeral supracondylar osteotomy for cubitus varus. The result was evaluated using Oppenheim criteria. Excellent or good cases were 94.4%. We concluded that tension band wiring is a satisfactory method of treatment for cubitus varus.

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Evaluation of tension-band osteosynthesis for cubitus varus deformity in pediatric patients: A retrospective review
Man Duc Minh Phan, Terry Richard Light, Tiep Van Phan, Phi Duong Nguyen
Journal of Hand and Microsurgery.2025; 17(2): 100213. CrossRef

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The Treatment of Supracondylar Fracture of The Humerus in Children: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Cheol Min Kim, Sang Hoon Ko, Seung Wook Jeong; J Korean Soc Fract 1997;10(2):393-400. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.393

Abstract PDF: Supracondylar fracture of distal humerus is up to 60% of all fractures around the elbow in children. Complications of this fracture include nerve injury, arterial injury, skin slough, Volkmanns ischemic contracuture, and changes in carrying angle. Many different treatment methods to minimize these complications have been devised. Recently, closed reduction and percutaneous pinning with K-wire is most widely used in treating supracondylar fractures in children exept in some rare cases such as unreducible fracture by closed reduction. However, troublesome changes in the carrying angle which do not interfere with function but the appearance of the arm is unsatisfactory, continue in approximately 30% of most series. We reviewed 59 cases which were treated by closed reduction and percutaneous pinning in supracondylar fracuture of the humerus. The purpose of our study is to evaluate the cosmetic and functional results and complications and to analysis the relationship between the stability of reduction and method of pinning. The results are as follows; 1) There were many cosmetic problems, actually. Change over 10 degrees in carrying angle compared to the normal site was as high as 10 cases(17%) of 59 cases. 2) There was no functional problem such as limitatioin of motion. 3) There was no significant complication. 4) The cross pinning fixation was more stable than lateral pinning fixation only. 5) Accurate anatomical reduction is required to prevent unsatisfactory result regardless the treatment method.

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Acceptable Angulation in Reduction of Humeral Supracondylar Fracture in Children: Seung Kwan Hwang, Jin Rok Oh; J Korean Soc Fract 1997;10(1):211-217. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.211

Abstract PDF: The purpose of this study is extraction of acceptable angulation range of humeral supracondylar fracture in children. Forty five cases of humeral supracondylar fracture were examined for 5 years and 5 months from February, 1990 to June, 1995. For analysis of the result according to angulation of distal fracture fragment of the reduction of fracture site, we measured the valgus-varus angle and rotatory angle of distal fracture fragment. Forty five cases were classified into three groups for the evaluation of result. If the distal fragment has valgus angulation below 5 degrees or rotaion angulation below 5 degrees, classified as group I. valgus angulation above 5 degrees and below 10 degrees or varus angulation below 5 degrees or rotation angulation above 5 degrees below 10 degrees, classified as group II, varus angulation above 5 degees or rotation angulation above 10 degrees, classified as group III. For evaluation of result, we standardized the range of motion, the change of carrying angle, the deformity of elbow. We gave point to these items, thus, total point above 10 points was evaluated as excellent, 8~9 points as good, below 7 points as unsatisfactory, Group I showed good result in 21 cases among 22 cases, in Group II, good result to in 16 cases among 18 cases. In Group I and II, the good result is 95%, 38 cases among 40 cases. Thus, we concluded that the acceptable range in reduction of humeral supracondylar fracture in children is valgus angle below 10 degrees, varus angle below 5 degrees, rotation angle below 10 degrees.

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Comparison of the Treatment of Displaced Extension Type Supracondylar Fractures of the Humerus in Children: Joo Chul Ihn, Byung Chul Park, Hee Su Kyung, Chang Wug Oh, Hak Su Kim; J Korean Soc Fract 1997;10(1):203-210. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.203

Abstract PDF: The treatment of supracondylar fracture of humerus in children has so many pitfalls as to be once called - supracondylar dilemma -. The authors analyzed the follow up results of 53 displaced extension type supracondylar fractures treated by closed reduction and cast, closed reduction and percutaneous pinning, skeletal traction and open reduction from 1993 to 1995. The following results were obtained : 1. Closed reduction and percutaneous pinning produced the best radiographic and clinical result by Flynns criteria when compared to other methods. 2. No difference in radiographical stability was found between percutaneous pinning with one medial and one lateral pin as opposed to two lateral pins. 3. There was a strong correlation between the change in Baumanns angle and the carrying angle(p=0.03).

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Delayed Management of Supracondylar and Intercondylar Fracture of the Femur Using the Composite Graft(Autograft+Processing Allograft): Young Kyun Woo, Seung Koo Rhee, Soen Yong Kwon, Hwa Sung Lee, Joo Yup Lee; J Korean Soc Fract 1996;9(4):951-957. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.951

Abstract PDF: There are many difficuties and problems to get anatomical reduction and rigid internal fixation in treatment of supracondylar and intercondylar fracture of the fumur. Authors reviewed and clinically analysed 7 patients w.ith svpracondylar and intercondylar fracture of the femur treated by delayed reconstruction from August 1993 to Decfmber 1995. Of 1 cases, there were 5 cases of open and 2 cases of closed fracture. According to AO classification, 7 cases were classified as followed; A3 type-l case, C2 type-4 cases, and C3 type-2 cases. They underwent surgical treatment at average 35 days after injury(range from 25 days to 58 days). Main causes of delay in surgical treatment were poor preoperative condition associated with mulliple injuries in 3 cases, wound problems at the site of open fracture in 3 cases and the combined state in 1 case. For internal fixation of fractures, a supracondylar nail in 4 cases and a dynamic condylar screw in 3 cases were used, and the bony defective area of fracture site in all 1 cases was replaced by the composite graft made of the autogenous cancellous bone and the processing allograft(Tutoplast). The period of follow up was from 8 months to 30 months(average time 14.8 months). There were no infection or allograft-rejection postoperatively. Clinical union was achieved from 6 months to 10 months in 6 cases, and nonunion associated with incomplete incorporation of graft bone was developed in 1 case. In 6 cases of clinical union, clinical assessment estimated by Schatzker and Lamberts criteria was fair in 1 case and failure in 5 cases, and change of tibiofemoral alignment occurred in 2 cases. The above poor clinical results could be considered to be derived from the delayed operative intervention resulting in joint stiffness due to soft tissue contracture, arthritis and large bony defect. In conclusion, even if it showed poor clinical results, the composite graft made of the autogenous cancellous bone and the pmcessing allograft could serve as a possible alternative for restoration of large bony defect in delayed management of supracondylar and intercondylar fracture of the fumur.

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Treatment of the Difficult Supracondylar Fracture of the Femur with the Intramedullary Supracondylar Nail: Bum Gu Lee, Yong Ju Kim, Suk Woong Yoon, Shin Young Kang, Jae Hee Cho, Myong Se Jang; J Korean Soc Fract 1996;9(4):943-950. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.943

Abstract PDF: Open reduction and internal fixation should be considered for the AO classification type C supracondylar fracture of the femur. However serious complications such as infection and nonunion can occur after extensive stripping of the soft tissue. We will analyze the usefulness of the intramedullary supracondylar nail for treatment of the 1 cases of the difficult supracondylar fracture such as AO type C fracture, nonunion and supracondylar fracture associated with ipsilateral hip fracture. Follow up period of 7 cases was at least 18 months. 1. 5 cases of 7 were AO type C and 2 cases of 7 were associated with ipsilateral hip fracture. 2. 2 cases of 1 rere nonunion and 2 cases of 7 were grade III open fracture in Gustilo classification. 3. 5 cases of 7 had bone union and average range of motion of the knee was 90 degree. 4. There was no infection, but t case was complicated with the femoral shaft fracture near the proximal nail tip, and 2 cases were complicated with the metal failure at the fracture site resulting nonunion. 5. Intramedullary supracondylar nail was very useful tool for the very difficult supracondylar fracture of the femur due to minimal incision, minimal soft tissue dissection and rigid fixation. But this nail was not available for the proximally extended fracture of the femoral shaft.

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Arthroscopieally Assisted Insertion of a Supracondylar Intramedullary Nail for Distal and Supracondylar Femoral Fracture: Technique Report: Sin Kang Cho, Jin Tae Choi, Sung Jae Kim; J Korean Soc Fract 1996;9(4):930-935. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.930

Abstract PDF: The retrograde supracondylar interlocking nail has been selectively used for the treatment of the supracondylar fracture of the femur. The open method using open medial arthrotomy increases the morbidity of the knee joint while the blind technique using minimal incision can cause the intra-articular complications owing to its blindness of procedure. In this article, we sought the safe method of insefion to reduce the complications of knee joint by minimal incision and also, using the auhroscopic guide. According to our method using arthrposcopic technique we concluded it has the potential benifits over the open or blind methods as early knee enercise, early soft tissue healing, decreased risk of damage to the intra-articular stiuctures, earlier convalescence with reduced hospitalization time, and better cosmesis.

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