OTA 1997 Posters - Pediatrics

A New Method of Maintaining Reduction during Operative Fixation of Pediatric Extension-Type Supracondylar Humerus Fractures

Paul F. Carroll, MD, Thomas J. Cartwright, MD, Henry Marano, MD

Jamaica, New York, USA

Five pediatric patients with type 2 or 3 extension type supracondylar humerus fractures were taken to the operating room for planned fixation. All patients were positioned, prepped, and draped in the normal fashion. Following full flexion of the elbow, a lateral image of the fracture was taken with the fluoroscopic imager to verify reduction of the fracture in the anteroposterior plane. A smooth kirshner wire was then inserted into the intramedullary canal, beginning posterior to the olecranon, through or just posterior to the articular surface of the distal humerus. The kirshner wire was directed across the fracture site, and up into the humeral diaphysis. The elbow could then be extended enough to allow a full anteroposterior view of the distal humerus without overlap of the radius or ulna, and without fear of redisplacing the fracture. At this point the rotational alignment of the distal fragment could be adjusted around the kirshner wire. The fracture was then pinned at the surgeon's discretion with lateral or cross kirshner wires. Following final acceptance of the fracture reduction and hardware position, the initial intramedullary kirshner wire was removed. All patients had routine postoperative care. At an average of two years, all patients were doing well.

Conclusion: In our hands, this technique allows for a more consistent reduction. In addition, it improves the intraoperative anteroposterior radiographic image of the fracture because the elbow can be extended without fear of displacing the fragments.

Significance: By improving the intra-operative visualization of the fracture and possibly decreasing operative time, this technique may decrease complications and enhance overall results.