Wednesday, November 9, 2011

Supracondylar Humerus Fractures- Does remodeling of the bone affect the clinical outcome? What is the bearing of fracture geometry and type of fixation on remodeling?

Adequacy of treatment, bone remodeling, and clinical outcome in pediatric supracondylar humeral fractures.
J Pediatr Orthop B. 2011 Sep 22. [Epub ahead of print]
Persiani P, Domenica MD, Gurzi M, Martini L, Lanzone R, Villani C.

Source: Department of Orthopedics, Policlinico Umberto I, Roma, RM, Italy.
Background: Completely displaced Gartland type III fractures should be addressed surgically, whereas Gartland type I fractures should be treated by casting alone. The best way to approach type II remains controversial, as it could be the first or second synthesis method, depending on fracture fragment stability after closed reduction.   We focused our study on two main aspects that influence the final outcome; the adequacy of treatment in relation to the Gartland types of fracture and the physeal remodeling
Material and Methods: The aim of this study was to evaluate and compare, both clinically and roentgenographically, 62 extension-type supracondylar fractures on the basis of the synthesis method and severity of the fracture, with a mean follow-up of 4 years and 3 months. Range of motion, axial alignment of the elbow, muscle strength, and joint stability were estimated and the Mayo Elbow Performance Index and the Pediatric Orthopaedic Society of North America Pediatric Outcomes Data Collection Instrument questionnaire were used. Furthermore, we took radiographic measurements (Baumann's angle, humero-capitellar angle, and lateral rotational percentage).
Results: According to Flynn criteria, the clinical outcome of all our patients was satisfactory. According to the results of the questionnaires, no patient has reported any disabling limitation of the elbow function. Radiographic study proved a greater capacity of remodeling in the sagittal plane compared with the frontal one, irrespective of severity of fracture assessed by the Gartland classification. Statistical analysis stressed the validity of postoperative Baumann's angle as a predictor of final carrying angle. With regard to the synthesis method, the best way to approach Gartland II fractures proved to be by closed reduction and percutaneous pinning; the use of a third Kirschner wire in the treatment of Gartland III fractures did not lead to a better result.

Conclusion: To conclude, remodeling positively influenced the clinical outcome, however, irrespective of synthesis method and severity of the fracture, we should pay more attention to the adequacy of reduction in frontal plane than in the sagittal one, for which a greater capacity of remodeling was proved.

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