Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Hailong ^1,2 , LIU Fang ² , ZHOU Zhilin ² , ZHANG Sicheng ² , HUA Zhongtuo ² , JIA Guoqiang ² ,  SUN Jun ²

1. The Fifth Clinical College of Anhui Medical University, Hefei Anhui, 230000, P. R. China;
2. Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China;

Corresponding?author：

SUN Jun, Email: Sunjun500@aliyun.com

Keywords：

Humeral supracondylar fracture; multi-directional unstable fracture; closed reduction; internal fixation; child

DOI：

10.7507/1002-1892.202307015

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Objective To investigate the effectiveness of medial and lateral column periosteal hinge reconstruction using Kirschner wire in the closed reduction of multi-directional unstable humeral supracondylar fractures in children. Methods A clinical data of 43 children with multi-direction unstable humeral supracondylar fractures, who met the selection criteria and were admitted between August 2020 and August 2022, was retrospectively analyzed. Twenty-one cases of fractures were treated wuth closed reduction after medial and lateral column periosteal hinge reconstruction using Kirschner wire and percutaneous Kirschner wires fixation (study group), while 22 cases of fractures were treated by traditional closed reduction technique and percutaneous Kirschner wire fixation (control group). There was no significant difference in gender, age, cause of injury, fracture side, and interval from injury to operation between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, the number of children who were changed to open reduction after closed reduction failure, fracture healing time, complications within 2 months after operation, and the Flynn score of elbow joint function at last follow-up were compared between the two groups. Results All the fractures in the study group were successfully closed reduction, and 4 cases in the control group were changed to open reduction and completed the operation, the difference between the two groups was significant (P=0.040). The operation time and intraoperative fluoroscopy times of the study group were significantly less than those of the control group (P<0.05). All children in both groups were followed up 6-18 months with an average of 9.0 months in the study group and 9.8 months in the control group. Imaging review showed that the fractures of both groups healed, and the difference in the healing time between the two groups was not significant (P=0.373). According to Flynn score at last follow-up, the excellent and good rate of elbow joint function was 95.2% (20/21) in the study group and 86.4% (19/22) in the control group, with no significant difference (P=0.317). There was no complication such as infection or irritation at the end of Kirchner wire within 2 months after operation. Conclusion For children with multi-directional unstable humeral supracondylar fractures, the use of Kirschner wires to reconstruct the medial and lateral column periosteal hinge to assist in closed reduction has the advantages of shortening operation time, reducing intraoperative fluoroscopy times, and effectively reducing the incidence of open reduction, and can achieve similar postoperative elbow joint function when compared with traditional closed reduction technique.

Citation： MA Hailong, LIU Fang, ZHOU Zhilin, ZHANG Sicheng, HUA Zhongtuo, JIA Guoqiang, SUN Jun. Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1220-1224. doi: 10.7507/1002-1892.202307015 Copy

1.	Pavone V, Vescio A, Accadbled F, et al. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop, 2022, 16(3): 208-219.
2.	Radaideh AM, Rusan M, Obeidat O, et al. Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture: A retrospective cohort study. World J Orthop, 2022, 13(3): 250-258.
3.	熊子軒, 趙胡日查, 祁凱, 等. 兒童多方向不穩定肱骨髁上骨折操縱桿輔助閉合復位技術的研究進展. 臨床小兒外科雜志, 2023, 22(6): 593-596.
4.	Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
5.	Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
6.	Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
7.	Silva M, Cooper SD, Cha A. The outcome of surgical treatment of multidirectionally unstable (type Ⅳ) pediatric supracondylar humerus fractures. J Pediatr Orthop, 2015, 35(6): 600-605.
8.	馬海龍, 管之也, 孫錫瑋, 等. 克氏針重建骨膜鉸鏈聯合“搟面杖”技術治療兒童屈曲橈偏型肱骨髁上骨折. 中華創傷雜志, 2022, 38(6): 545-550.
9.	孫亮, 劉萬林, 韋宜山, 等. 半無菌技術在閉合復位經皮克氏針內固定治療兒童肱骨髁上骨折中的應用. 中華小兒外科雜志, 2019, 40(6): 536-539.
10.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
11.	Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
12.	Georgescu I, Gavriliu S, Parvan A, et al. Burnei’s “double X” internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions: Study and Research Group in Pediatric Orthopaedics-2012. J Med Life, 2013, 6(2): 131-139.
13.	Lee HY, Kim SJ. Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique. J Bone Joint Surg (Br), 2007, 89(5): 646-650.
14.	Aktekin CN, Toprak A, Ozturk AM, et al. Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type Ⅲ supracondylar humerus fractures. J Pediatr Orthop B, 2008, 17(4): 171-178.
15.	周志林, 馬海龍, 孫軍, 等. 拇指撥擋技術在兒童Gartland Ⅲ型肱骨髁上骨折尺側穿克氏針中的應用. 中國修復重建外科雜志, 2023, 37(2): 142-146.

1. Pavone V, Vescio A, Accadbled F, et al. Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society. J Child Orthop, 2022, 16(3): 208-219.
2. Radaideh AM, Rusan M, Obeidat O, et al. Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture: A retrospective cohort study. World J Orthop, 2022, 13(3): 250-258.
3. 熊子軒, 趙胡日查, 祁凱, 等. 兒童多方向不穩定肱骨髁上骨折操縱桿輔助閉合復位技術的研究進展. 臨床小兒外科雜志, 2023, 22(6): 593-596.
4. Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
5. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
6. Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
7. Silva M, Cooper SD, Cha A. The outcome of surgical treatment of multidirectionally unstable (type Ⅳ) pediatric supracondylar humerus fractures. J Pediatr Orthop, 2015, 35(6): 600-605.
8. 馬海龍, 管之也, 孫錫瑋, 等. 克氏針重建骨膜鉸鏈聯合“搟面杖”技術治療兒童屈曲橈偏型肱骨髁上骨折. 中華創傷雜志, 2022, 38(6): 545-550.
9. 孫亮, 劉萬林, 韋宜山, 等. 半無菌技術在閉合復位經皮克氏針內固定治療兒童肱骨髁上骨折中的應用. 中華小兒外科雜志, 2019, 40(6): 536-539.
10. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
11. Wei YS, Liu WL, Bai R, et al. The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop B, 2020, 29(5): 452-457.
12. Georgescu I, Gavriliu S, Parvan A, et al. Burnei’s “double X” internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions: Study and Research Group in Pediatric Orthopaedics-2012. J Med Life, 2013, 6(2): 131-139.
13. Lee HY, Kim SJ. Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique. J Bone Joint Surg (Br), 2007, 89(5): 646-650.
14. Aktekin CN, Toprak A, Ozturk AM, et al. Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type Ⅲ supracondylar humerus fractures. J Pediatr Orthop B, 2008, 17(4): 171-178.
15. 周志林, 馬海龍, 孫軍, 等. 拇指撥擋技術在兒童Gartland Ⅲ型肱骨髁上骨折尺側穿克氏針中的應用. 中國修復重建外科雜志, 2023, 37(2): 142-146.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children

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