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Pediatric Supracondylar Hum.rus Fractures: Are m.dial Pins Indicated?

Open Journal of Orthopedics 2014年第5期4卷 123-129页

作者： Bobby Dezfuli Christopher Larkins John T. Ruth lisa m. truchan Departm.nt of Orthopaedic Surgery University of Arizona Medical Center Tucson AZ USA Departm.nt of Orthopaedic Surgery University of Texas Health Science Center San Antonio TX USA

Background: Pediatric supracondylar hum.rus fractures are the m.st com.on elbow fractures in children. Operative m.nagem.nt includes closed reduction and placem.nt of 2 to 3 laterally based pins. Occasionally, a m.dial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcom.s in the operative m.nagem.nt of pediatric supracondylar hum.rus fractures at a level one academ.c traum. center. m.terials & m.thods: A retrospective review was perform.d on all children sustaining a Gartland type II or III supracondylar hum.rus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academ.c traum. center by two of the authors (JTR, Lm.). Pin placem.nt patterns were evaluated and com.ared based on year perform.d. Outcom.s m.asured were rates of ulnar nerve sym.tom., non-union, re-operation, and varus m.lalignm.nt. Data analysis was perform.d using a Fisher exact test on STATA software. Results: A total of 49 patients m.t inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From.2009-2011, 16 (59%) were type II and 11 (41%) were type III. Com.arison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Com.arison of pinning pattern in type III fractures during the sam. tim. period did show that there was a statistically significant decrease (p = 0.010) in the num.er of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus m.lalignm.nt in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar hum.rus fractures with equivalent clinical outcom.s at a Level I traum. center. Furtherm.re, perform.ng lateral pinning for type III fractures has elim.

关键词： Supracondylar Hum.rus Fracture Pin Fixation Ulnar Nerve Injury Biom.chanical Stability

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