Volume 7 | Issue 3 | September-December 2021 | Page: 02-07 | Sandeep Patwardhan, Bismaya Sahoo, Vivek Sodhai, Parag Sancheti, Ashok Shyam, Mrunal Kodape
Authors: Sandeep Patwardhan MS Ortho. , Bismaya Sahoo MS Ortho. , Vivek Sodhai MS Ortho. , Parag Sancheti MS Ortho. , Ashok Shyam MS Ortho. [1, 2], Mrunal Kodape D. Ortho. 
 Department of Orthopaedic, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
 Research department, Indian Orthopaedic Research Group, Thane [W], Maharashtra, India.
Address of Correspondence
Dr Bismaya Sahoo
Department of Orthopaedic, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Introduction: Closed reduction percutaneous pinning (CRPP) is the standard treatment for displaced supracondylar fractures of humerus (SCH) in children. The purpose of our study is to analyze the functional outcomes of percutaneous Kirschner wire fixation of SCH fractures in paediatric population using a novel “arm board” technique.
Materials and Methods: A prospective study was carried out between October 2015 to October 2017 which included 71 patients of SCH fracture. Outcome evaluation was performed using Flynn’s score and Skagg’s grading. Age, gender, type of fracture, position of k-wires and time to surgery were also recorded. All patients were followed up for a minimum period of one year
Results: 90% were graded as excellent, 8.5% good, 1.5% fair according to Flynn’s score. By Skagg’s grading there was no loss of reduction in any patient. There were no significant differences in the outcomes based on age, gender, type of fracture, position of k-wires and time to surgery.
Conclusion: Good functional outcomes can be achieved with the “arm board” technique irrespective of age, gender, type of fracture, duration between injury and procedure if satisfactory reduction of the fracture can be achieved. Our technique uses a simple, locally fabricated radiolucent arm board that can be adapted to any standard operating table. It is a novel and innovative method that is safe, effective and can be easily replicated by orthopedic surgeons managing paediatric fractures.
Level of evidence: Therapeutic, Level III
Keywords: “arm board” technique, closed reduction percutaneous pinning, Paediatric; Supracondylar humerus fracture
1. Lee BJ, Lee SR, Kim ST, et al (2011) Radiographic Outcomes after treatment of pediatric supracondylar humerus fractures using a treatment-based classification system. J Orthop Trauma. 2011 Jan;25(1):18-25 https://doi.org/10.1097/BOT.0b013e3181db7d70
2. Minkowitz B, Busch MT (1994) Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am 1994 Oct;25(4):581-94
3. Scott J. Mubarak, Jon R. Davids. Closed Reduction and Percutaneous Pinning of Supracondylar Fractures of the Distal Humerus in the Child. In: The Elbow. Editor: Bernard F. Morey. LippincottWilliams& Wilkins. Pages 54-65.
4. Tolo VT, Skaggs DLet al(2007) Master Techniques in Orthopaedic Surgery: PaediatricOrthopaedics. Philadelphia: Lippincott; p. 1-15.
5. Slongo T, Schmid T, Wilkins K, Joeris A.(2008) Lateral external fixationa new surgical technique for displaced unreducible supracondylar humeral fractures in children. J Bone Joint Surg Am;90:1690-7.
6. Jayakumar P, Ramachandran M.(2014) Elbow Injuries in Children. In: Bentley G, editors. European Surgical Orthopaedics and Traumatology. Berlin, Heidelberg: Springer;
7. Guler O, Mutlu S, Isyar M, Mutlu H, Cerci H, Mahirogullari M(2016) Prone versus supine position during surgery for supracondylar humeral fractures. J Orthop Surg;24:167-9.
8. Vuillermin C, May C, Kasser J.(2018) Closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures. JBJS Essential Surgical Technique;8(2):e10(1-2).
9. Young S, Fevang JM, Gullaksen G, et al (2010) Deformity and functional outcome after treatment for supracondylar humerus fractures in children: A 5- to 10-year follow-up of 139 supracondylar humerus fractures treated by plaster cast, skeletal traction or crossed wire fixation. J Child Orthop 4:445–453. https://doi.org/10.1007/s11832-010-0274-6
10. Younus S, Peracha A, Kamran S, et al (2018) Percutaneous Pinning for Displaced Supracondylar Humerus Fractures in Pediatric Age Group : Comparison between Lateral Pinning Versus Crossed Pinning Techniques. 1–4. https://doi.org/10.19080/OROAJ.2018.11.555817
11. Maity A, Saha D, Roy DS (2012) A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children. J Orthop Surg Res 7:1–8. https://doi.org/10.1186/1749-799X-7-6
12. Uçar BY, Demirtaş a, Uçar DE (2012) Treatment approaches and outcomes in childhood supracondylar humerus fractures. Eur Rev Med Pharmacol Sci 16:936–41
13. J, Bayisenga & Ssebuufu, Robinson & D.S, Mugenzi. (2013). Early Outcome of Delayed Management of Supracondylar Humeral Fractures in Children in Rwanda. East and Central African Journal of Surgery. 18. 94.
14. Asghar, K., Nazir, S., & Maqbool, N. (2018). Functional Outcome in Triceps Muscle Sparing Versus Muscle Splitting Approach in Pediatric Supracondylar Humerus Fracture. Journal of Pakistan Orthopaedic Association, 30(02), 49-53. Retrieved from http://jpoa.org.pk/index.php/upload/article/view/205
15. Gartland JJ (1959) Management of supracondylar fractures of the humerus in children.Surg Gynecol Obs 109:145–154
16. Flynn JC, Matthews JG, Benoit RL (1974) Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 56:263–272
17. Sodhai VM, Patwardhan SA, Alao SO, Shyam AK, Haphiz A.(2019) Arm Board Technique for Closed Reduction Percutaneous Pinning of Displaced Supracondylar Fractures of Humerus in Children: Technical Note. Journal of Orthopaedic Case Reports Nov-Dec;9(6): 98-101
18. John A. Herring M (2014) Baumann’s Angle. Tachdjian’s Pediatric Orthopaedics textbook 3:1271–1272
19. Bahk MS, Srikumaran U, Ain MC, et al (2008) Patterns of pediatric supracondylar humerus fractures. J Pediatr Orthop.Jul-Aug;28(5):493-9. PMID: 18580360 https://doi.org/10.1097/BPO.0b013e31817bb860
20. John A. Herring M (2014) Carrying Angle. Tachdjian’s Pediatric Orthopaedics textbook 1:25–26
21. Skaggs DL, Cluck MW, Mostofi A, et al (2004) Lateral-Entry Pin Fixation in the Management of Supracondylar Fractures in Children. J Bone Jt Surg Apr;86(4):702-7. https://doi.org/10.2106/00004623-200404000-00006
22. Carvalho RA, Franco Filho N, Castello Neto AB, et al (2012) Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados. Rev Bras Ortop 47:705–709. https://doi.org/10.1590/S0102-36162012000600005
23. Acar E, Memik R (2017) Surgical Treatment Results in Pediatric Supracondylar Humerus Fractures. Eurasian J Emerg Med 8–11. https://doi.org/10.5152/eajem.2017.74046
24. Ababneh M, Shannak A, Agabi S, Hadidi S (1998) The treatment of displaced supracondylar fractures of the humerus in children. A comparison of three methods. Int Orthop 22:263–265
25. Campbell CC, Waters PM, Emans JB, et al (1995) Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 15:47–52. https://doi.org/10.1097/01241398-199501000-00011
26. Cheng JC, Lam TP, Shen WY (1995) Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 9:511–515
27. Nirmal Raj Gopinathan, Mohammad Sajid, Pebam Sudesh(2018) Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration. Indian J Orthop 52:554–560. https://doi.org/10.4103/ortho.IJOrtho
28. Danielsson L, Pettersson H (1980) Open reduction and pin fixation of severely displaced supracondylar fractures of the humerus in children. Acta Orthop Scand 51:249–255
29. Han Q, Wang Y, Liu F (2011) Comparison of complications and results of early versus delayed surgery for Gartland type III supracondylar humeral fractures in pediatric patients. Orthop Surg 3:242–246. https://doi.org/10.1111/j.1757-7861.2011.00153.x
30. Iyengar SR, Hoffinger SA, Townsend DR (1999) Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. J Orthop Trauma 13:51–55
31. Isa AD, Furey A, Stone C (2014) Functional outcome of supracondylar elbow fractures in children: A 3- to 5-year follow-up. Can J Surg 57:241–246. https://doi.org/10.1503/cjs.019513
|How to Cite this Article: Patwardhan S, Sahoo B, Sodhai V, Sancheti P, Shyam A, Kodape M | Outcomes of Closed Reduction Percutaneous Pinning in Paediatric Supracondylar Humerus Fractures using “Arm Board” Technique ” | International Journal of Paediatric Orthopaedics | September- December 2021; 7(3): 02-07.|