Clinical Research
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The Effect of Pin Configuration and Crossing Angle on Coronal, Sagittal and Rotational Stability in Pediatric Supracondylar Humerus Fractures Treated with Cross Pinning

Year 2023, Volume: 13 Issue: 3, 425 - 430, 21.09.2023
https://doi.org/10.33631/sabd.1342418

Abstract

Aim: This study aimed to examine the effect of different pin configurations and angles of the pin crossing angle (PCA) on the stability of supracondylar humeral fractures (SHFs) in children who underwent cross pinning treatment by radiological measurements and to evaluate these findings.
Material and methods: This study retrospectively analyzed the radiological outcomes of 111 children with SHFs who underwent cross-pinning treatment. Anteroposterior and lateral elbow x-rays were taken before surgery, one day after surgery, and one month after surgery. The x-rays were used to measure Baumann’s angle (BA), humerocondylar angle (HCA), lateral rotation percentage (LRP), and pin crossing angle (PCA). The effects of pin configuration and PCA on BA, HCA, and LRP were evaluated.
Results: This study found significant improvements in LRP, PCA, and BA from preoperative to postoperative one month (p<0.001). However, the number of pins (2+1 or 3+1) did not affect the postoperative first day or first month LRP, PCA, and BA (p>0.05). Likewise, the PCA above or below 90° did not influence the postoperative first month LRP, PCA, and BA (p>0.05).
Conclusion: This study concluded that pin configuration or PCA did not affect the stability of cross-pinned fractures in terms of rotation or coronal and sagittal stability. These results suggest that, to the extent allowed by the anatomy of the distal humerus, the cross-pinning technique may be sufficient in terms of fracture stability in all three planes when employed with proper settings. We also propose that LRP can be used to assess and monitor the reduction quality of pediatric SHFs.

References

  • Vaquero-Picado A, Gonzalez-Moran G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018; 3(10): 526-40.
  • Gartland J. Management of supracondylar fractures of the humerus in children. Surgery, gynecology & obstetrics. 1959; 109(2): 145-54.
  • Casiano E. Reduction and fixation by pinning "banderillero" style-fractures of the humerus at the elbow in children. Mil Med. 1960; 125: 262-4.
  • Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am. 1974; 56(2): 263-72.
  • Claireaux H, Goodall R, Hill J, Wilson E, Coull P, Green S, et al. Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children. Chin J Traumatol. 2019; 22(5): 249-54.
  • Chong HH, Qureshi A. Pediatric distal humeral supracondylar fracture - achievement of optimal pinning configuration. Acta Orthop Belg. 2022; 88(2): 245-54.
  • Khurana A, Byrne C, Evans S, Tanaka H, Haraharan K. Comparison of transverse wires and half pins in Taylor Spatial Frame: a biomechanical study. J Orthop Surg Res. 2010; 5: 23.
  • Skaggs DL. Elbow fractures in children: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons. 1997; 5(6): 303-12.
  • Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture stability after pinning of displaced supracondylar distal humerus fractures in children. Journal of Pediatric Orthopaedics. 2001; 21(3): 313-8.
  • Paradis G, Lavallee P, Gagnon N, Lemire L. Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop Relat Res. 1993(297):231-7.
  • Camp J, Ishizue K, Gomez M, Gelberman R, Akeson W. Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures. J Pediatr Orthop. 1993; 13(4): 521-5.
  • Simanovsky N, Lamdan R, Hiller N, Simanovsky N. The measurements and standardization of humerocondylar angle in children. J Pediatr Orthop. 2008; 28(4): 463-5.
  • Williamson DM, Coates CJ, Miller RK, Cole WG. Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures. J Pediatr Orthop. 1992; 12(5): 636-9.
  • Katzmann H. On the treatment of supracondylar upper arm fractures in children. Zentralbl Chir. 1965; 90(40): 2089-97.
  • Von Ekesparre W. Treatment of supracondylar fractures of the humerus in childhood. Dtsch Med J. 1958; 9(4): 168-73.

Çapraz Pinleme ile Tedavi Edilen Çocuk Suprakondiler Humerus Kırıklarında Pin Konfigürasyonu ve Çaprazlama Açısının Koronal, Sagittal ve Rotasyonel Stabiliteye Etkisi

Year 2023, Volume: 13 Issue: 3, 425 - 430, 21.09.2023
https://doi.org/10.33631/sabd.1342418

Abstract

Amaç: Çapraz pinleme tekniği ile tedavi edilen pediatrik suprakondiler humerus kırıklarında (SHK) pin konfigürasyonu ve çaprazlama açısı (PÇA) ile kırık stabilitesi arasındaki ilişkiyi radyolojik ölçümlerle incelemek ve bulguları değerlendirmek amaçlandı.
Gereç ve Yöntemler: Bu çalışmada, çapraz pinleme uygulanan 111 pediatrik SHK’lı hasta retrospektif olarak analiz edildi. Hastaların ameliyat öncesi, ameliyat sonrası birinci gün ve birinci ayda alınan dirsek ön-arka ve yan grafilerinde Baumann açısı (BA), humerokondiler açı (HKA), lateral rotasyon yüzdesi (LRY) ve ameliyat sonrası birinci ayda PÇA değerleri hesaplandı. Pin konfigürasyonu ve PÇA’nın BA, HKA ve LRY üzerindeki etkisi değerlendirildi.
Bulgular: Ameliyat öncesi ile ameliyat sonrası birinci ay arasında LRY, HKA ve BA değerlerinde anlamlı iyileşme görüldü (p<0,001). Ancak, pin sayısı (2+1 veya 3+1) LRY, HKA ve BA değerlerini ameliyat sonrası birinci gün veya birinci ayda etkilemedi. Aynı şekilde, PÇA’nın 90° üstü veya altı olması da ameliyat sonrası birinci ayda LRY, HKA ve BA değerlerini etkilemedi.
Sonuç: Sonuçlarımız çapraz pinleme yönteminde pin konfigürasyonu veya PÇA’ nın koronal ve sagittal düzlem stabilitesi yanında rotasyonel stabilite ile de ilişkili olmadığını gösterdi. Bu sonuç distal humerus anatomisinin elverdiği ölçüde, uygun teknikle yapılan çapraz pinlemenin üç planda da kırık stabilitesi açısından yeterli olduğunu göstermektedir. Bunun yanında, LRY’ nin pediatrik SHK sonrası redüksiyonun değerlendirilmesi ve takibinde uygulanabilir olabileceğini de düşünmekteyiz.

References

  • Vaquero-Picado A, Gonzalez-Moran G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018; 3(10): 526-40.
  • Gartland J. Management of supracondylar fractures of the humerus in children. Surgery, gynecology & obstetrics. 1959; 109(2): 145-54.
  • Casiano E. Reduction and fixation by pinning "banderillero" style-fractures of the humerus at the elbow in children. Mil Med. 1960; 125: 262-4.
  • Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am. 1974; 56(2): 263-72.
  • Claireaux H, Goodall R, Hill J, Wilson E, Coull P, Green S, et al. Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children. Chin J Traumatol. 2019; 22(5): 249-54.
  • Chong HH, Qureshi A. Pediatric distal humeral supracondylar fracture - achievement of optimal pinning configuration. Acta Orthop Belg. 2022; 88(2): 245-54.
  • Khurana A, Byrne C, Evans S, Tanaka H, Haraharan K. Comparison of transverse wires and half pins in Taylor Spatial Frame: a biomechanical study. J Orthop Surg Res. 2010; 5: 23.
  • Skaggs DL. Elbow fractures in children: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons. 1997; 5(6): 303-12.
  • Gordon JE, Patton CM, Luhmann SJ, Bassett GS, Schoenecker PL. Fracture stability after pinning of displaced supracondylar distal humerus fractures in children. Journal of Pediatric Orthopaedics. 2001; 21(3): 313-8.
  • Paradis G, Lavallee P, Gagnon N, Lemire L. Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop Relat Res. 1993(297):231-7.
  • Camp J, Ishizue K, Gomez M, Gelberman R, Akeson W. Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures. J Pediatr Orthop. 1993; 13(4): 521-5.
  • Simanovsky N, Lamdan R, Hiller N, Simanovsky N. The measurements and standardization of humerocondylar angle in children. J Pediatr Orthop. 2008; 28(4): 463-5.
  • Williamson DM, Coates CJ, Miller RK, Cole WG. Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures. J Pediatr Orthop. 1992; 12(5): 636-9.
  • Katzmann H. On the treatment of supracondylar upper arm fractures in children. Zentralbl Chir. 1965; 90(40): 2089-97.
  • Von Ekesparre W. Treatment of supracondylar fractures of the humerus in childhood. Dtsch Med J. 1958; 9(4): 168-73.
There are 15 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Murat Yeşil 0000-0003-4386-9120

Bilge Kağan Yılmaz 0000-0002-2765-7833

Recep Altın 0000-0001-6162-0666

Mehmet Nuri Konya 0000-0002-5877-8347

Publication Date September 21, 2023
Submission Date August 13, 2023
Published in Issue Year 2023 Volume: 13 Issue: 3

Cite

Vancouver Yeşil M, Yılmaz BK, Altın R, Konya MN. Çapraz Pinleme ile Tedavi Edilen Çocuk Suprakondiler Humerus Kırıklarında Pin Konfigürasyonu ve Çaprazlama Açısının Koronal, Sagittal ve Rotasyonel Stabiliteye Etkisi. VHS. 2023;13(3):425-30.