Outcomes of Closed Reduction Percutaneous Pinning in Paediatric Supracondylar Humerus Fractures Using “Arm Board” Technique “

Volume 7 | Issue 3 | September-December 2021 | Page: 02-07 | Sandeep Patwardhan, Bismaya Sahoo, Vivek Sodhai, Parag Sancheti, Ashok Shyam, Mrunal Kodape
DOI-10.13107/ijpo.2021.v07i03.114

Authors: Sandeep Patwardhan MS Ortho. [1], Bismaya Sahoo MS Ortho. [1], Vivek Sodhai MS Ortho. [1], Parag Sancheti MS Ortho. [1], Ashok Shyam MS Ortho. [1, 2], Mrunal Kodape D. Ortho. [1]

[1] Department of Orthopaedic, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] 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.
E-mail: bismay.ltmc.bs@gmail.com

Abstract

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

References

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
DOI: 10.13107/jocr.2250-0685.1608
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.

(Article Text HTML)      (Full Text PDF)

A Rare Unreported Case of Comminuted Bicondylar Hoffa’s Fracture

Volume 7 | Issue 3 | September-December 2021 | Page: 23-25 | Gaurav Gupta, Qaisur Rabbi, Maulin Shah, Vikas Bohra
DOI-10.13107/ijpo.2021.v07i03.118

Authors: Gaurav Gupta MS Ortho. [1], Qaisur Rabbi D Ortho. [1], Maulin Shah MS Ortho. [1], Vikas Bohra DNB Ortho. [1]

[1] Department of Orthopaedic, OrthoKids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr Maulin Shah
Consultant Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujarat, India.
E-mail: maulinmshah@gmail.com

Abstract

A coronal plane fracture of the distal femur (Hoffa’s fracture) is very uncommon and usually occurs as a consequence of high velocity trauma. Bicondylar involvement of coronal femoral fractures is even less common, especially in children. To our knowledge, this is the first case report of a comminuted bicondylar Hoffa’s fracture in the paediatric age group managed by low profile solid locking screws.
A fourteen-year-old boy was referred with complaints of pain, swelling and deformity of the left knee after a fall from a height of approximately 10 feet. Clinical examination of the left knee revealed swelling and effusion with a low-lying patella and multiple superficial abrasions. X-ray of the left knee revealed bicondylar Hoffa’s fracture (Letenneur type III, Salter Harris type III). Computed tomography (CT) revealed a comminuted non-conjoint bicondylar Hoffa’s fracture with a low-lying patella. The fracture was approached through an anterior midline incision. Extensor mechanism of the knee was found intact. Fracture fragments were reduced anatomically and held in compression with long ball-tipped clamps. Four screws were placed in an antero-posterior (two screws for each condyle) and two screws in a medio-lateral direction to achieve a strong fixation construct. The screws were kept entirely in the epiphysis. At 12 months follow-up, the patient was walking with a normal gait, and full extension and 90 degrees of flexion at the knee. Quadricepsplasty was performed at 1 year to improve knee flexion. At final follow up of 2 years, he had full range of knee motion with no functional limitation.
Keywords: Hoffa’s, Bicondylar, Adolescent, Comminuted, Quardricepsplasty

References

1. White, E. A., Matcuk, G. R., Schein, A., Skalski, M., Maracek, G. S., Forrester, D.M., & Patel, D. B. (2014). Coronal plane fracture of the femoral condyles: anatomy, injury patterns, and approach to management of the Hoffa’s fragment. Skeletal Radiology, 44(1), 37–43.
2. Harna B, Goel A, Singh P, Sabat D. Pediatric conjoint Hoffa’s fracture: An uncommon injury and review of literature. J Clin Orthop Trauma. 2017;8(4):353–354.
3. Lal H, Bansal P, Khare R, Mittal D. Conjoint bicondylar Hoffa’s fracture in a child: a rare variant treated by minimally invasive approach. J Orthop Traumatol. 2011;12(2):111–114.
4. Hoffa’s A. Lehrbuch der Frakturen und Luxationen. Stuttgart: Verlag von Ferdinand Enke. 1904; p. 451.
5. Ul Haq R, Modi P, Dhammi I, Jain AK, Mishra P. Conjoint bicondylar Hoffa’s fracture in an adult. Indian J Orthop. 2013;47(3):302–306.
6. Giotikas D1, Nabergoj M1, Krkovic M1. Surgical management of complex intra-articular distal femoral and bicondylar Hoffa’s fracture. Ann R Coll Surg Engl. 2016 Nov;98(8): e168-e170.
7. Kondreddi V, Yalamanchili RK, Ravi Kiran K. Bicondylar Hoffa’s fracture with patellar dislocation – a rare case. J Clin Orthop Trauma. 2014;5(1):38–41.
8. Mak W, Hunter J, Escobedo E. Hoffa’s Fracture of the Femoral Condyle. Radiology Case Reports [Online]. 2008; 3:231.
9. Xiao, K., Chen, C., Yang, J., Yang, D., & Liu, J. An attempt to treat Hoffa’s fractures under arthroscopy: A case report. Chinese Journal of Traumatology. 2018 Oct; 21(5): 308–310.
10. Thompson TC. Quadricepsplasty to improve knee function. J Bone Joint Surg Am. 1944;26:366–79.

How to Cite this Article:  Gupta G, Rabbi Q, Shah M, Bohra V | A Rare Unreported Case of Comminuted Bicondylar Hoffa’s Fracture | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 23-25.

(Article Text HTML)      (Full Text PDF)

Late Presentation and Reconstruction of Fingertip Crush Injury in a Child: A Unique Case Report

Volume 7 | Issue 3 | September-December 2021 | Page: 38-41 | Parag Lad, Sanket Tanpure
DOI-10.13107/ijpo.2021.v07i03.122

Authors: Parag Lad D Ortho. [1], Sanket Tanpure DNB Ortho. [1]

[1] Department of Orthopaedic, Jupiter Lifeline Hospital, Thane, Maharashtra, India.

Address of Correspondence
Dr. Sanket Tanpure,
Department of Orthopaedic, Jupiter Lifeline Hospital, Thane, Maharashtra, India.
E-mail: sankettanpure55@gmail.com

Abstract

Introduction: The fingertip is the most commonly injured part of the hand; therefore, fingertip injuries are among the most frequent injuries that surgeons are required to treat. Crush injuries of the fingertip are typically due to compression by a closing door. We report a late presentation of fingertip crush injury and its management on the dominant little finger in a child.
Case presentation: A 2-year-old male presented with infected and early necrosis of dominant hand little fingertip, caused due to door crush injury. The patient presented at 35 days with an exposed distal phalanx, marginal necrosis and partially healed, ulnarly-placed pulp of the fingertip. The parents of the child were counselled for one attempt of thorough debridement and consideration of pulp adipo-fascial flap repositioning to cover the distal phalanx. Local debridement and trimming of the pulp skin edges were carried out. The ulnarly displaced pulp was repositioned on the tip to cover the distal phalanx and sutured to the radial aspect of the nail fold with absorbable sutures. At 2 years follow up, the injured little finger was normal in cosmesis, function and nail growth.
Conclusion: Healing potential in children is good. Thorough debridement, nailbed and pulp reconstruction to cover the tip of distal phalanx and immobilisation for two weeks help to provide better cosmesis in the form of normal contour of the fingertip and movements, even in late presenting cases.
Keywords: Childhood crush injury, Fingertip, Late presentation, Debridement

References

1. Glicenstein J. and Haddad R. Management of fingertip injury in the child. In: Foucher G. (ed.), Fingertip and Nailbed Injuries. Churchill Livingstone, 1991: pp. 120-128.
2. Doraiswamy NV, Baig H. Isolated Finger injuries in chil¬dren-incidence and aetiology. Injury. 2000;31(8):571-3.
3. Fetter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18(5):341-5.
4. Ljungberg E, Rosberg HE, Dahlin LB. Hand injuries in young children. J Hand Surg Br. 2003;28(4):376-80.
5. Fetter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18(5):341 345.
6. Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care. 2014;30(10):742-745.
7. Van Beek AL, Kassan MA, Adson MH, Dale V. Management of acute fingernail injuries. Hand clinics. 1990 Feb 1;6(1):23-35.
8. Kubus M, Andrzejewska E, Kuzanski W. Fingertip injuries in children treated in Department of Pediatric Surgery and Oncology in the years 2008-2010 [abstract only]. Ortop Traumatol Rehabil. 2011;13(6):547-554.
9. Innis PC. Office evaluation and treatment of finger and hand injuries in children. Curr Opin Pediatr. 1995;7(1):83-87.
10. de Alwis W. Fingertip injuries. Emerg Med Australas. 2006;18(3):229-237.
11. Macgregor DM, Hiscrox JA. Fingertip trauma in children from doors. Scot Med J. 1999;44(4):114-115.
12. Yorlets RR, Busa K, Eberlin KR, Raisolsadat MA, Bae DS, Waters PM, Labow BI, Taghinia AH. Fingertip injuries in children: epidemiology, financial burden, and implications for prevention. Hand. 2017 Jul;12(4):3427.
13. Giddins GE, Hill RA. Late diagnosis and treatment of crush injuries of the fingertip in children. Injury. 1998 Jul 1;29(6):447-50.
14. Karakas AO, Yuce E. Evaluation of pediatric fingertip injuries using etiology, demographics and therapy. The Medical Bulletin of Sisli Etfal Hospital. 2020;54(3):306.

How to Cite this Article:  Tanpure S, Lad P | Late Presentation and Reconstruction of Fingertip Crush Injury in a Child: A Unique Case Report | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 38-41.

(Article Text HTML)      (Full Text PDF)

September-December 2021

Click On The Image 

September-December 2021

September-December 2021

Editorial

Volume 7 | Issue 3 | September-December 2021 | Page: 01 | Jayant  S. Sampat
DOI-10.13107/ijpo.2021.v07i03.113

Authors: Jayant S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Dear friends and colleagues
This issue of IJPO features original articles and case reports on a wide variety of paediatric orthopaedic conditions ranging from congenital deformities to infection and trauma. The POSI fraternity from India and around the globe have been sending in their submissions on a regular basis. This has enabled the IJPO team to publish twelve articles in this issue including 4 original papers, a new record for the POSI journal.
The “arm board” technique for the management of supracondylar fractures highlights the constant innovations being introduced into surgical practice by POSI members. Barick and colleagues have conducted a well-designed prospective study on walking age in children with clubfoot. Their work will help us to counsel parents of children with clubfoot appropriately. Other original articles on the management of osteoid osteoma and hemi-epiphyseodesis of the ankle add to the existing literature and provide new insights into the management of these conditions.
The case reports represent an eclectic mix of conditions from the rare “dysosteosclerosis” to the common problem of fingertip injuries in children. Each report is well written and presented to convey a clear message to the reader. On behalf of the Editorial Board, we commend each of the authors for their contribution and recognise the significant effort involved in seeing a submission through to publication. In the background, a large team of paediatric orthopaedic surgeons have provided their invaluable support for the peer-review process.
This issue also showcases the non-surgical skills of POSI members. Our cover page illustration is by Dr Easwar. T. R from Palakkad who dedicates his considerable artistic gift for charitable causes. Dr Taral Nagda has overseen the style and presentation of IJPO since its inception, in addition to creating previous cover page illustrations.
We have evolved substantially over the last 18 months. From reliance on invited article and symposia in the early days, IJPO is now composed entirely of original research work.
As always, we request interested POSI members to send in their submissions to the journal, volunteer to review articles and join the Editorial Board of the journal. Please visit our website www.ijpoonline.com for further details.

Jayanth S Sampath FRCSEd (Tr & Orth)
Editor, International Journal of Paediatric Orthopaedics (IJPO), POSI
editor.ijpo@gmail.com

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 01.

(Article Text HTML)      (Download PDF)