Background:
Pediatric supracondylar humeral fractures are common and challenging
injuries. The preferred approach is early closed reduction and
percutaneous pinning; however, this fails in up to 25% of patients,
and conversion to open reduction, especially in late-presenting
patients, has been reported in 3% to 46% of patients due to severe
swelling or skin problems around the elbow. This study presents a
reduction technique that uses a temporary intrafocal Kirschner wire
to allow indirect and more effective manipulation of the distal
fragment, facilitating closed reduction in difficult situations.
Methods:
This study retrospectively evaluated the results of an intrafocal joystick
technique that was used to aid closed reduction in 15 patients with
late-presenting, displaced supracondylar humeral fractures with
unfavorable soft-tissue conditions around the elbow. The mean
patient age was 6±2.7 yr and the mean injury-to-surgery interval
(delay) was 4±2.7 days. Baumann’s angle, humerocapitellar angle,
the anterior humeral line-capitellum relationship were used for
radiographic evaluation of the initial reduction and throughout the
follow-up that lasted for a mean of 9.4±3.6mo. The functional and
cosmetic outcomes were assessed according to Flynn’s criteria and
the Mayo Elbow Performance Index.
Results:
None of the patients could be successfully treated with the
standard method. The intrafocal joystick technique succeeded in
achieving acceptable closed reduction in 12 of 15 patients; the
remaining three patients required open reduction and internal
fixation. All fractures united, and wires were removed at a mean
of 5.4±1.6 wk. Functional range of motion was regained after a
mean period of 7.2±3.5 wk, while full elbow range of motion
was regained after a mean period of 12.2±3.5 wk. According to
Flynn’s criteria and the Mayo Elbow Performance Index, all
patients had an excellent result.
Conclusions:
The intrafocal joystick technique for closed reduction and percutaneous
fixation of irreducible supracondylar fractures of the humerus in
certain difficult situations can effectively and safely achieve satisfactory
radiographic and functional outcomes and decrease the need for
conversion to an open reduction. Open reduction and internal fixation
are essential in some patients but should only be used after all
techniques of closed reduction and percutaneous fixation have failed.
Level of Evidence:
Level III retrospective. |
