Comparison of Operative Techniques for Closed Reduction of Supracondylar Humerus Fractures in Children

Chimelie Chibututu, R. Jay Lee M.D., Department of Orthopaedic Surgery at Johns Hopkins School of Medicine (department of my faculty mentor), Johns Hopkins University, 480 Wallenberg Crescent, Mississauga, Ontario, Canada, L5B 3M1

Background: Fractures of the supracondylar are among the most common fractures in children. Despite their ubiquity there is no agreement on the ideal technique for surgical reduction. While some believe the cross-pins technique provides greater stability and minimizes loss of reduction, it has been associated with higher risk of post-operative neuropathy. As a result, others are in favor the lateral-entry technique – which avoids the ulnar nerve but has been associated with lower stability. Past work has indicated that if differences in outcomes between the two techniques exist, they may be related to degree of elbow flexion during pin placement as well as the greater stability of the cross-pins construct. Thus, the goal of this review is to compare prone position cross-pins constructs, supine position cross-pins constructs, and mini-medial cross-pins constructs to lateral-entry constructs in terms of loss of reduction, and incidence of post-operative neuropathy.  
Methods: A review of the literature from 2000 – October 2020 was performed using Science, PubMed, Google Scholar and the Journal of Pediatric Orthopedics using keywords “lateral-entry”, “supracondylar humerus fracture”, “closed reduction” and “ulnar nerve injury.” Randomized clinical trials were given priority but cohort studies were also included. We will perform a statistical analysis of the rates of loss of reduction and post-operative neuropathy for each technique.
Results: Given the recent success of prone position cross-pins constructs we predict that the incidence of post-operative neuropathy will be lower in this group than in the supine position or lateral-entry groups.
Conclusions: Modifications to the current techniques for fracture fixation may result in lower incidence of ulnar nerve damage while still retaining optimal stability.

Additional Abstract Information

Presenter: Chimelie Chibututu

Institution: Johns Hopkins University

Type: Poster

Subject: Health & Human Development

Status: Approved

Time and Location

Session: Poster 7
Date/Time: Tue 3:30pm-4:30pm
Session Number: 5097