2019, Vol. 3 Issue 1, Part C
Supracondylar fractures of humerus are the most common elbow fracture in children. The treatment of this fracture is very difficult because of the instability of the fragments and grave soft tissue injuries which may lead to complications. Percutaneous pinning techniques have become the treatment of choice for most supracondylar fracture of humerus.
Objectives: To assess and compare clinical (functional and cosmetic) and radiological results and complications of two types fixation technique [cross pin fixation (CPF) versus posterior intrafocal and lateral pin fixation (PILPF)] for extension type closed supracondylar fracture humerus.
Methodology: This study was done prospectively on patients having extension type supracondylar fracture of humerus in children admitted in the Department of Orthopaedic, SMS Medical College & Hospital, Jaipur during the February 2012 to November 2013. A total of 168 cases (84 in each category) were studied. Patients were divided into two groups, in first group all 84 patients were managed by CPF while in second group, by PILPF method with K-wire.
Results: There were 5 cases (5.95%) of significant cubitus varus in PILPF and 4 cases (4.76%) in CPF. There was significant loss of range of movement at elbow in 6 cases (7.14%) in PILPF group and 4 cases (4.76%) in CPF group. There were 5 cases of iatrogenic nerve injury in CPF group. In PILPF group, overall results were satisfactory in 94.04% and in CPF group in 95.23% cases, for the cosmetic factor. Final result for cosmetic factor according to flynn's criteria: 72.61% cases have excellent results in CPF group while only 44.04% cases were in PILPF group (p value <0.05, statistically significant). In PILPF group, overall results were satisfactory in 92.85% cases and in CPF group in 95.23% cases, for the functional factor. Final result for functional factor (movement loss) according to flynn's criteria: 57.14% cases have excellent result in CPF group while 47.61% were in PILPF group (p value >0.05, statistically not significant). We find significant change in Baumann's angle of abnormal side in both groups (p value<0.05).
Conclusion: CPF method is better than PILPF method while considering biomechanical stability, but PILPF method is safe. It does not carry risk of ulnar nerve injury.