Functional Outcome Following Closed Reduction and Percutaneous Pinning and Open Reduction and Pinning in Displaced Supracondylar Fractures of the Humerus in Children: A Single Center Study
Keywords:Displaced supracondylar fracture, open reduction, percutaneous pinning, Flynn criteria, carrying angle, Baum-ann’s angle
AbstractAbstract: Objective: The aim of the study was to evaluate the functional outcome of closed reduction and percutaneous pinning (CRPCP) and open reduction and internal fixation (ORIF) after failed closed reduction in displaced supracondylar fractures of the humerus in children. Methods: It’s a prospective study conducted from September 2013 to October 2015. Total of 40 patients who fulfilled the inclusion and exclusion criteria were included in this study. Only one attempt of closed reduction under fluoroscope guidance was done in all the patients. The cases in which reduction was achieved closely were managed with CRPCP and were placed in group A while those cases in which closed reduction was unsuccessful were managed with ORIF via posterior approach and were placed in group B. The fractures were stabilized using cross pinning and was splinted postoperatively in long arm back-slab at 800 of flexion. Patients were followed up for 3 months. Functional assessment was done using Flynn criteria, and carrying angle (CA) for the cosmetic outcome. The time of union was used to assess the radiological outcome. Results: Twenty- four patient were in group A and 16 patients were in group B. The average age of the patient in group A was 6.17 ± 1.09 years (range 4-8 years) while that in group B was 6.69 ± 1.08 years (range 5-10 years). Male to female ratio in both group was 1.67. Average time to union was significantly better in group A than group B (5.71 ± 0.69 weeks vs 6.88 ± 0.62 weeks). There was no statistically significant difference in Baumann angle, carrying angle (CA) of affected limb and loss of range of motion (ROM) in both group. In group A, 22 (92%) patient had excellent result while 2 (8%) patient had good result according to Flynn criteria. In group B, 14 (87.5%) patient had excellent result, 1 (6.25%) patient had good and fair result each. We had 3 cases of ulnar palsy in group A while no ulnar nerve injury was recorded in group B. Conclusion: The functional outcome was comparable in both group and thus we recommend low threshold to conversion to open reduction where closed reduction fails to reduce further damage to soft tissue in displaced supracondylar fracture of humerus in children. Earlier union was achieved with CRPCP than with ORIF.
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