METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS

Authors

  • Olexander Buryanov Bogomolets National Medical University, Kyiv. Ukraine, Ukraine https://orcid.org/0000-0002-2174-1882
  • Volodymyr Kvasha Bogomolets National Medical University, Kyiv. Ukraine, Ukraine https://orcid.org/0000-0002-7444-6289
  • Valerija Naumenko Bogomolets National Medical University, Kyiv. Ukraine, Ukraine
  • Dmytro Kovalchuk Bogomolets National Medical University, Kyiv. Ukraine, Ukraine
  • Oleg Pylypchuk Bogomolets National Medical University, Kyiv. Ukraine, Ukraine
  • Taras Omelchenko Bogomolets National Medical University, Kyiv. Ukraine, Ukraine
  • Valentyn Rohozynskyi National Military Medical Clinical Center "Main Military Clinical Hospital", Kyiv. Ukraine, Ukraine https://orcid.org/0000-0001-9891-0739

DOI:

https://doi.org/10.15674/0030-59872024376-85

Keywords:

Supracondylar fractures of distal humerus in pediatric patients, treatment, methods of fixation, pinning configuration, biomechanical analysis of pin placement, meta-analysis

Abstract

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation configurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct.

Author Biographies

Olexander Buryanov, Bogomolets National Medical University, Kyiv. Ukraine

MD, Prof. in Orthopaedics and Traumatology

Volodymyr Kvasha, Bogomolets National Medical University, Kyiv. Ukraine

MD, Prof. in Orthopaedics and Traumatology

Valerija Naumenko, Bogomolets National Medical University, Kyiv. Ukraine

MD

Dmytro Kovalchuk, Bogomolets National Medical University, Kyiv. Ukraine

MD, PhD

Oleg Pylypchuk, Bogomolets National Medical University, Kyiv. Ukraine

MD, PhD

Taras Omelchenko, Bogomolets National Medical University, Kyiv. Ukraine

MD, Prof

Valentyn Rohozynskyi, National Military Medical Clinical Center "Main Military Clinical Hospital", Kyiv. Ukraine

MD, PhD

References

  1. Santos, I. A., Cruz, M. A., Souza, R. C., Barreto, L. V., Monteiro, A. F., & Rezende, L. G. (2024). Epidemiology of supracondylar fractures of the humerus in children. Archives of health investigation, 13(1), 18–23. https://doi.org/10.21270/archi.v13i1.6324
  2. Mubarak, F. S., Mohamed Anzar, M. A., & Kanagratnam, K. (2023). Descriptive study on epidemiology, clinical presentation, treatment, and outcome of Supracondylar fractures treated in a base hospital of Sri Lanka: A single-center study. Cureus. https://doi.org/10.7759/cureus.40494
  3. Gartland, J. J. (1959). Management of supracondylar fractures of the humerus in children. Journal of surgery, gynecology & obstetrics, 109(1), 145–154
  4. Heal, J., Bould, M., Livingstone, J., Blewitt, N., & Blom, A. (2007). Reproducibility of the Gartland classification for Supracondylar humeral fractures in children. Journal of orthopaedic surgery, 15(1), 12–14. https://doi.org/10.1177/230949900701500104
  5. Leitch, K., Kay, R., Femino, J., Tolo, V., Storer, S., & Skaggs, D. (2006). Treatment of Multidirectionally unstable Supracondylar humeral fractures in children. The journal of bone & joint surgery, 88(5), 980–985. https://doi.org/10.2106/jbjs.d.02956
  6. Zaidman, M., Eidelman, M., Abu-Dalu, K., & Kotlarsky, P. (2023). Pediatric Supracondylar fracture of the humerus with sideward displacement. Surgical techniques development, 12(3), 107–118. https://doi.org/10.3390/std12030010
  7. Duffy, S., Flannery, O., Gelfer, Y., & Monsell, F. (2021). Overview of the contemporary management of supracondylar humeral fractures in children. European Journal of orthopaedic surgery & traumatology, 31(5), 871–881. https://doi.org/10.1007/s00590-021-02932-2
  8. Lin-Guo, Zhang, X., Yang, J., Wang, Z., Qi, Y., Shan-Zhu, & Meng, X. (2018). A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children. Journal of orthopaedic surgery and research, 13(1). https://doi.org/10.1186/s13018-018-0806-1
  9. Xing, B., Dong, B., & Che, X. (2023). Medial–lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: A meta-analysis of randomized controlled trials. Journal of orthopaedic surgery and research, 18(1). https://doi.org/10.1186/s13018-023-03528-8
  10. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100
  11. Kamara, A., Ji, X., Liu, T., Zhan, Y., Li, J., & Wang, E. (2018). A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal Junction fractures of the distal humerus in children. International orthopaedics, 43(2), 411–416. https://doi.org/10.1007/s00264-018-3968-x
  12. Liu, C., Kamara, A., Liu, T., Yan, Y., & Wang, E. (2020). Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal Junction fractures of the distal humerus in children: A finite element analysis. Journal of orthopaedic surgery and research, 15(1). https://doi.org/10.1186/s13018-020-1564-4
  13. Kamara, A., Ji, X., Liu, C., Liu, T., & Wang, E. (2021). The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model. Injury, 52(6), 1310–1315. https://doi.org/10.1016/j.injury.2021.01.012
  14. Oztermeli, A. (2023). Is lateral onset cross pin technique strong enough? A biomechanical study. SiSli etfal hastanesi tip bulteni / The medical bulletin of Sisli hospital, 495–499. https://doi.org/10.14744/semb.2023.87528
  15. Wallace, M., Johnson, D. B., Pierce, W., Iobst, C., Riccio, A., & Wimberly, R. L. (2019). Biomechanical assessment of torsional stiffness in a Supracondylar humerus fracture model. Journal of pediatric orthopaedics, 39(3), e210–e215. https://doi.org/10.1097/bpo.0000000000001270
  16. Bitzer, A. M., Belkoff, S. M., LiBrizzi, C. L., Chibututu, C., & Lee, R. J. (2021). Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures. Medicine, 100(22), e26173. https://doi.org/10.1097/md.0000000000026173
  17. Nunes, M. C., Posser, T. D., Israel, C. L., Spinelli, L. d., Calieron, L. G., & Kim, J. H. (2019). Análise biomecânica de dois tipos de fixação de fratura supracondiliana de úmero Em modelo anatômico. Revista Brasileira de ortopedia, 54(03), 261–267. https://doi.org/10.1055/s-0039-1688756
  18. Hanim, A., Wafiuddin, M., Azfar, M. A., Awang, M. S., & Nik Abdul Adel, N. A. (2021). Biomechanical analysis of crossed pinning construct in Supracondylar fracture of humerus: Does the point of crossing matter? Cureus. https://doi.org/10.7759/cureus.14043
  19. Pothong, W., Phinyo, P., Sirirungruangsarn, Y., Nabudda, K., Wongba, N., Sarntipiphat, C., & Pruksakorn, D. (2021). Biomechanical analysis of sagittal plane pin placement configurations for pediatric Supracondylar humerus fractures. Applied sciences, 11(8), 3447. https://doi.org/10.3390/app11083447
  20. Durusoy, S. (2021). The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis. Joint diseases and related surgery, 32(1), 75–84. https://doi.org/10.5606/ehc.2021.77279
  21. Wang, W., Li, Q., Kamara, A., Han, Z., Liu, T., & Wang, E. (2022). Analysis of the location and trajectory of the Kirschner wires in the fixation of extension-type supracondylar fracture of the humerus by 3D computational simulation. Journal of shoulder and elbow surgery, 31(7), 1368–1375. https://doi.org/10.1016/j.jse.2021.12.048
  22. Acar, E., & Memik, R. (2020). Surgical treatment results in pediatric Supracondylar humerus fractures. Eurasian journal of emergency medicine, 19(1), 25–29. https://doi.org/10.4274/eajem.galenos.2017.74046
  23. Natalin, H. M., Silva, J. C., & Volpon, J. B. (2021). Comparison of two methods of fixation of supracondylar fractures of the humerus in children. Acta ortopédica Brasileira, 29(5), 263–267. https://doi.org/10.1590/1413-785220212905240542
  24. Prashant, K., Lakhotia, D., Bhattacharyya, T. D., Mahanta, A. K., & Ravoof, A. (2016). A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus. Journal of orthopaedics and traumatology, 17(3), 223–229. https://doi.org/10.1007/s10195-016-0410-2
  25. Abubeih, H., El-Adly, W., El-Gaafary, K., & Bakr, H. (2019). Percutaneous cross-pinning versus two lateral entry pinning in Gartland type III pediatric supracondylar humerus fractures. The Egyptian orthopaedic journal, 54(1), 52. https://doi.org/10.4103/eoj.eoj_15_1
  26. Afaque, S. F., Singh, A., Maharjan, R., Ranjan, R., Panda, A. K., & Mishra, A. (2020). Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial. Journal of clinical orthopaedics and trauma, 11(2), 259–263. https://doi.org/10.1016/j.jcot.2019.01.013
  27. Naik, L. G. (2017). Cross pinning versus lateral pinning in the management of type III Supracondylar humerus fractures in children. Journal of clinical and diagnostic research. https://doi.org/10.7860/jcdr/2017/28481.10351
  28. KN, A., K, R., J, V., NV, S., Paila, S. P., & Reddy N, N. P. (2018). A prospective study of crossed versus lateral pinning for displaced extension-type supracondylar fractures of humerus. International journal of orthopaedics sciences, 4(4), 737–740. https://doi.org/10.22271/ortho.2018.v4.i4i.90
  29. Palange, N. D., GS, P., Mane, A., & Pawar, E. (2019). A comparison between percutaneous cross K wire and lateral K wires fixation in management of type III Gartland paediatric supracondylar fractures. International journal of orthopaedics sciences, 5(2.2), 119–122. https://doi.org/10.22271/ortho.2019.v5.i2c.22
  30. Othman, M. K., & Hamawand, S. (2020). Percutanous crossed pinning versus two lateral pinning for treating Supracondylar humeral fracture in children: Comparative study. Kirkuk Journal of medical sciences, 8(1), 64–77. https://doi.org/10.32894/kjms.2020.169357
  31. PR, N., & PR, C. (2017). A prospective study of crossed versus lateral only pinning in the treatment of displaced supracondylar fractures of the humerus in children. International Journal of orthopaedics sciences, 3(3f), 400–404. https://doi.org/10.22271/ortho.2017.v3.i3f.70
  32. Radaideh, A. M., Rusan, M., Obeidat, O., Al-Nusair, J., Albustami, I. S., Mohaidat, Z. M., & Sunallah, A. W. (2022). Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture: A retrospective cohort study. World journal of orthopedics, 13(3), 250–258. https://doi.org/10.5312/wjo.v13.i3.250
  33. Napora, J., Mazur, N., & Trzciński, R. (2022). Supracondylar humerus fractures in children — a retrospective study. Chirurgia narządów ruchu i ortopedia Polska, 87(2), 57–62. https://doi.org/ 10.31139/88.2.9691
  34. Ercin, E. (2015). Medial mini-open versus percutaneous pin fixation for type 3 supracondylar fractures in children. Turkish journal of trauma and emergency surgery. https://doi.org/10.5505/tjtes.2015.20268

Downloads

How to Cite

Buryanov, O. ., Kvasha, V., Naumenko, V., Kovalchuk, D. ., Pylypchuk, O. ., Omelchenko, T. ., & Rohozynskyi, V. . (2024). METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 76–85. https://doi.org/10.15674/0030-59872024376-85

Issue

No. 3 (2024)

Section

DIGESTS AND REVIEWS

License

Copyright (c) 2024 Олександр Бур'янов, Володимир Кваша, Валерія Науменко, Дмитро Ковальчук, Олег Пилипчук, Тарас Омельченко, Валентин Рогозинський

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.

Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.

The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).