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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Nerve Injury | Research

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Authors: Jun Sun, Jing Shan, Lian Meng, Tianjing Liu, Enbo Wang, Guoqiang Jia

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Objective

The incidence of open reduction and internal fixation (ORIF) in flexion-type supracondylar humerus fractures (SCHF) in children is significantly higher than that of extension-type fractures. This study aimed to identify risk factors for ORIF in flexion-type SCHF.

Methods

One hundred seventy-one patients with Wilkins type III flexion-type SCHF from January 2012 to December 2021 were retrospectively enrolled in a tertiary paediatric hospital. Patients were divided into ORIF group versus closed reduction and internal fixation (CRIF) group. Then, patients data of age, sex, injury side, obesity, deviation of displacement, fracture level, rotation, nerve injury, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios (OR) of ORIF.

Results

Overall, 171 children with type III flexion-type SCHF were analyzed (average aged 7.9 ± 2.8 years). Displacement was lateral in 151 cases, medial in 20. 20 cases had combined ulnar nerve injury. The failed closed reduction rate was 20%. Univariate analysis indicated age, distal fracture fragment rotation, and ulnar nerve injury were significantly associated with ORIF. (P = 0.047, P = 0.009, and P = 0.001, respectively). Multivariate logistic regression analysis showed that distal fracture fragment rotation (OR, 3.3; 95%CI:1.1–9.5; P = 0.028) and ulnar nerve injury (OR, 6.4; 95%CI:2.3–18.3; P = 0.001) were independent risk factors; however, the age was not an independent one (OR, 1.5; 95%CI:0.6–3.5; P = 0.397) for ORIF in the Wilkins type III flexion-type SCHF.

Conclusion

Distal fracture fragment malrotation on initial x-rays and ulnar nerve injury were significant risk factors for ORIF in Wilkins type III flexion-type SCHF. Surgeons should prepare tourniquets or other open reduction instruments when treating these types of fractures.

Level of evidence

Level IV

Available only for authorised users

Cheng JC, Lam TP, Mafulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001;10:63–7.PubMed

De Boeck H. Flexion-type supracondylar elbow fractures in children. Journal of Pediatric Orthopaedics. 2001;21(4):460–3.CrossRefPubMed

Zorrilla SNJ, Prada-Cañizares A, Marti-Ciruelos R, et al. Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop. 2015;39:2287–96. https://doi.org/10.1007/s00264-015-2975-4.CrossRef

Wilkins KE. The operative management of supracondylar fractures. Orthop Clin North Am. 1990;21(2):269–89.CrossRefPubMed

Mulpuri K, Hosalkar H, Howard A. AAOS clinical practice guideline: the treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg. 2012;20(5):328–30. https://doi.org/10.5435/JAAOS-20-05-328.CrossRefPubMed

Garg B, Pankaj A, Malhotra R, et al. Treatment of flexion-type supracondylar humeral fracture in children. J Orthop Surg (Hong Kong). 2007;15(2):174–6. https://doi.org/10.1177/230949900701500210.CrossRef

Ojeaga P, Wyatt CW, Wilson P, et al. Pediatric type II supracondylar humerus fractures: factors associated with successful closed reduction and immobilization. J Pediatr Orthop. 2020;40(8):e690–6. https://doi.org/10.1097/BPO.0000000000001586.CrossRefPubMed

Madjar-Simic I, Talic-Tanovic A, Hadziahmetovic Z, et al. Radiographic assessment in the treatment of supracondylar humerus fractures in children. Acta Inform Med. 2012;20(3):154–9. https://doi.org/10.5455/aim.2012.20.154-159.CrossRefPubMedPubMedCentral

Kao HK, Lee WC, Yang WE, et al. Clinical significance of anterior humeral line in supracondylar humeral fractures in children. Injury. 2016;47(10):2252–7. https://doi.org/10.1016/j.injury.2016.06.037.CrossRefPubMed

10.

Flynn K, Shah AS, Brusalis CM, et al. Flexion-type supracondylar humeral fractures: ulnar nerve injury increases risk of open reduction. J Bone Joint Surg Am. 2017;99(17):1485–7. https://doi.org/10.2106/JBJS.17.00068.CrossRefPubMed

11.

Kuoppala E, Parviainen R, Pokka T, et al. Low incidence of flexion-type supracondylar humerus fractures but high rate of complications. Acta Orthop. 2016;87(4):406–11. https://doi.org/10.1080/17453674.2016.1176825.CrossRefPubMedPubMedCentral

12.

Steinman S, Bastrom TP, Newton PO, et al. Beware of ulnar nerve entrapment in flexion-type supracondylar humerus fractures. J Child Orthop. 2007;1(3):177–80. https://doi.org/10.1007/s11832-007-0034-4.CrossRefPubMedPubMedCentral

13.

Chukwunyerenwa C, Orlik B, El-Hawary R, et al. Treatment of flexion-type supracondylar fractures in children: the ‘push–pull’ method for closed reduction and percutaneous K-wire fixation. J Pediatr Orthop B. 2016;25(5):412–6. https://doi.org/10.1097/BPB.0000000000000241.CrossRefPubMed

14.

Green BM, Stone JD, Bruce RW, et al. The use of a transolecranon pin in the treatment of pediatric flexion-type supracondylar humerus fractures. J Pediatr Orthop. 2017;37(6):e347–52. https://doi.org/10.1097/BPO.0000000000000904.CrossRefPubMed

15.

Kao HK, Lee WC, Yang WE, et al. Treatment of displaced flexion-type pediatric supracondylar humeral fractures in the prone position. J Orthop Surg (Hong Kong). 2017;25(1):2309499016684412. https://doi.org/10.1177/2309499016684412.CrossRef

16.

Kang S, Kam M, Miraj F, et al. The prognostic value of the fracture level in the treatment of Gartland type III supracondylar humeral fracture in children. Bone Joint J. 2015;97-B(1):134–40. https://doi.org/10.1302/0301-620X.97B1.34492.CrossRefPubMed

17.

Kim KY, Conaway W, Schell R, et al. Prevalence of ulnar nerve palsy with flexion-type supracondylar fractures of the humerus. J Pediatr Orthop B. 2020;29(2):133–6. https://doi.org/10.1097/BPB.0000000000000702.CrossRefPubMed

18.

Turgut A, Kalenderer Ö, Bozoğlan M, et al. Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic. Eklem Hastalik Cerrahisi. 2015;26(3):151–7. https://doi.org/10.5606/ehc.2015.31.CrossRefPubMed

19.

Delniotis I, Dionellis P, Gekas CC, et al. Flexion-type supracondylar humeral fracture with ulnar nerve injury in children: two case reports and review of the literature. Am J Case Rep. 2020;21(21):e921293. https://doi.org/10.12659/AJCR.921293.CrossRefPubMedPubMedCentral

20.

Schultz JD, Rees AB, Wollenman LC, et al. Bruise location in supracondylar humerus fractures predicts specific neurovascular injuries. J Pediatr Orthop. 2022;42(3):e250–6. https://doi.org/10.1097/BPO.0000000000002027.CrossRefPubMed

21.

Lim KB, Lim CT, Tawng DK. Supracondylar humeral fractures in children: beware the medial spike. Bone Joint J. 2013;95-B(9):1290–4. https://doi.org/10.1302/0301-620X.95B9.31683.CrossRefPubMed

22.

Novais EN, Carry PM, Mark BJ, et al. Posterolaterally displaced and flexion-type supracondylar fractures are associated with a higher risk of open reduction. J Pediatr Orthop B. 2016;25(5):406–11. https://doi.org/10.1097/BPB.0000000000000314.CrossRefPubMedPubMedCentral

23.

Çabuk H, Dedeoğlu SS, Adaş M, et al. Medial spike and obesity associate with open reduction in type III supracondylar humeral fracture. Acta Chir Orthop Traumatol Cech. 2016;83(2):102–5.PubMed

24.

Li NY, Bruce WJ, Joyce C, et al. Obesity’s influence on operative management of pediatric supracondylar humerus fractures. J Pediatr Orthop. 2018;38(3):e118–21. https://doi.org/10.1097/BPO.0000000000001126.CrossRefPubMed

25.

Prusick VW, Gibian JT, Ross KE, et al. Surgical technique: closed reduction and percutaneous pinning of posterolaterally displaced supracondylar humerus fractures. J Orthop Trauma. 2021;35(3):e108–15. https://doi.org/10.1097/BOT.0000000000001854.CrossRefPubMed

26.

Bekmez S, Camp MW, Ling R, et al. Supracondylar humerus fractures in older children: success of closed reduction and percutaneous pinning. J Pediatr Orthop. 2021;41(4):242–8. https://doi.org/10.1097/BPO.0000000000001732.CrossRefPubMed

27.

Walmsley PJ, Kelly MB, Robb JE, et al. Delay increases the need for open reduction of type-III supracondylar fractures of the humerus. J Bone Joint Surg Br. 2006;88(4):528–30. https://doi.org/10.1302/0301-620X.88B4.17491.CrossRefPubMed

28.

Okkaoglu MC, Ozdemir FE, Ozdemir E, et al. Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours? J Orthop Surg Res. 2021;16(1):484. https://doi.org/10.1186/s13018-021-02638-5.CrossRefPubMedPubMedCentral

29.

Yang J, Sun LJ, Du Shenghu, et al. Risk factors of failure in closed reduction for supracondylar fractures of humerus in children. Chin J Pediat Surg. 2013;34(12):904–6. https://doi.org/10.3760/cma.j.issn.0253-3006.2013.12.008.CrossRef

30.

Beck JD, Riehl JT, Moore BE, et al. Risk factors for failed closed reduction of pediatric supracondylar humerus fractures. Orthopedics. 2012;35(10):1492–6. https://doi.org/10.3928/01477447-20120919-18.CrossRef

31.

Sibinski M, Sharma H, Bennet GC. Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children. J Bone Joint Surg Br. 2006;88(3):380–1. https://doi.org/10.1302/0301-620X.88B3.17181.CrossRefPubMed

32.

Abdelmalek A, Towner M, Clarke A. Are we staying up too late? Timing of surgery of displaced supracondylar fractures in children. Clinical audit in a paediatric tertiary UK trauma centre and literature review. Arch Orthop Trauma Surg. 2022;9. https://doi.org/10.1007/s00402-021-04289-x.

Title: Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children
Authors: Jun Sun
Jing Shan
Lian Meng
Tianjing Liu
Enbo Wang
Guoqiang Jia
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Nerve Injury
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05798-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive factors for open reduction of flexion-type supracondylar fracture of humerus in children

Abstract

Objective

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Level of evidence

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