Does Late Presentation of Displaced Supracondylar Humerus Fracture in Children Influence Outcomes of Surgery?
Dr. Puspak Samal,
Assistant Professor, Institute of Medical Science and SUM Hospital, SOA University,
Kalinganagar, Bhubaneswar-753001, Odisha, India.
Introduction: Displaced Supracondylar Humerus Fracture (SCHF) in children is usually treated with percutaneous pinning on emergency basis in fresh cases. Though there are spectrum of modalities treatment reported, still paucity of literature available to compare between cross versus lateral pinning in late presented cases with massive swelling and poor soft tissue condition.
Aim: To compare the efficacy and safety of percutaneous medial-lateral cross Kirschner wire (K-wire) and two lateral K-wire fixation in treatment of displaced SCHF in children.
Materials and Methods: We retrospectively reviewed the functional and radiological result of treatment in 58 children (aged 2-12 years) with displaced SCHF presented more than two days duration after injury. Among 58 patients, (n=31) treated with cross K-wire (Group A) and (n=27) treated two lateral K-wire fixation (Group B). Statistical analysis of different variables was performed using SPSS software (version 20.0; SPSS, Chicago, Illinois). A p-value of <0.05 was considered to be statistically significant.
Results: Both the group were similar in terms of mean demographic variables. Mean delay of presentation was 4.07 days and 4.87 days in Group A versus Group B respectively. In Group A, three patient had iatrogenic ulnar nerve injury. There were also no significant differences (p>0.05) between groups with respect to the Baumann angle, change in the Baumann angle, Flynn grade, carrying angle, elbow range of motion, return to function, or complications.
Conclusion: Although both the technique appears to be equally effective in term of stability and outcomes. But lateral pinning has a definite edge over cross pinning in respect to reduced incidence of iatrogenic ulnar nerve injury, especially in late presenters with severe swelling and poor soft tissue conditions.