Complications after pinning of supracondylar distal humerus fractures.

نویسندگان

  • Ravi K Bashyal
  • Jennifer Y Chu
  • Perry L Schoenecker
  • Matthew B Dobbs
  • Scott J Luhmann
  • J Eric Gordon
چکیده

BACKGROUND Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications. METHODS A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases. RESULTS The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the operating room for repeat reduction and pinning. Three patients developed compartment syndromes. Ulnar nerve injury was rare with only 1 postoperative ulnar nerve injury occurring in 311 patients treated with a medial pin (0.3%). CONCLUSIONS Closed reduction with percutaneous pinning is effective and has a low complication rate with a very low rate of infection even when simple betadine preparation and towel draping are used. Preoperative antibiotics seem to have little effect on infection rate. LEVEL OF EVIDENCE Level III retrospective comparative study.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Risk factors of loss reduction after percutaneous fixation in supracondylar humerus in pediatric: a descriptive-analytical study

Background & Aims: supracondylar humerus fracture is one of the most common pediatric elbow fractures accounting for about 16% of the pediatric fractures. Loss of reduction is one of the complications after closed and percutaneous fixation. This research is aimed to investigate the factors involved in the loss of reduction. Method: In this descriptive study, the children with supracondylar hum...

متن کامل

Pseudomonas aeruginosa Septic Arthritis and Osteomyelitis after Closed Reduction and Percutaneous Pinning of a Supracondylar Humerus Fracture: A Case Report and Review of the Literature

Infectious complications of closed reduction and percutaneous pinning of supracondylar humerus fractures are exceedingly rare. Although postoperative Pseudomonas infection is a feared complication associated with noncompliance and a wet cast, there are no reports in the literature of this occurring. We present the devastating complication of a pediatric patient who developed Pseudomonas aerugin...

متن کامل

Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration

PURPOSE Supracondylar fractures of the humerus are the most common fracture of the elbow in children. The purpose of this study was to evaluate, in terms of outcomes and complications, Gartland type III pediatric supracondylar humerus fractures treated at a pediatric level-one trauma center over a 7-year period, specifically addressing the impact of time to surgery on the incidence of complicat...

متن کامل

Treatment of Displaced Supracondylar Fracture of Humerus in Children by Lateral Entry Pinning versus Cross Pinning

Introduction: Displaced supracondylar fractures of humerus are one of the most common fractures in pediatric age group with preferred treatment being close reduction with percutaneous K-wire fi xation. This study compares whether lateral pin construct alone can provide same stability like cross (medial and lateral) pin fi xation, and prevent iatrogenic ulnar nerve injury. Materials and Methods:...

متن کامل

The outcome and parents-based cosmetic satisfaction following fixation of paediatric supracondylar humerus fractures treated by closed method with or without small medial incision

Supracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin f...

متن کامل

Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography

Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the e...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Journal of pediatric orthopedics

دوره 29 7  شماره 

صفحات  -

تاریخ انتشار 2009