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Background: Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. Case presentation: A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient's elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. Conclusion: In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case. [ABSTRACT FROM AUTHOR]

Abstract Background Due to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus. Case presentation A 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications. Conclusion In this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Supracondylar fractures of the distal humerus are the most common fracture around the elbow in children. A thorough initial assessment must be conducted to identify any associated neurovascular injury and carefully documented. The assessment should include a vascular examination of the radial pulse, temperature, colour and capillary refill time. A neurological examination must comment on the motor and sensory function of the radial, median and ulnar nerves. X-rays allow an evaluation of the fracture location and type, and the degree of displacement. Immobilisation in plaster is the gold standard treatment for paediatric supracondylar fracture of the humerus where the degree of displacement is within acceptable parameters. Casting should be followed by orthogonal radiographs and a repeat neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge, and the child reviewed in a fracture clinic within 1 week of the injury. The British Orthopaedic Association Standards for Trauma and Orthopaedics for supracondylar fractures of the humerus in children are useful for junior orthopaedic and emergency medicine clinicians to refer to when dealing with these injuries. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of dexamethasone combined with ropivacaine brachial plexus block (BPB) on postoperative analgesia in children with supracondylar fracture of humerus. Methods: 140 children with supracondylar fracture of humerus were randomly divided into control group (70 cases) and experimental group (70 cases) . After anesthesia, BPB was performed under ultrasound guidance in both groups. The control group was given 0.25 % ropivacaine solution, and the experimental group was given a mixture of 0.25 % ropivacaine and 0.1 mg/kg dexamethasone. The pain block time of the two groups was recorded. FLACC score was used to evaluate the degree of pain at 10 min after recovery, 2 h, 6 h, 12 h and 24 h after operation. The use of analgesic drugs within24 hours after operation was recorded in the two groups. The first time to get out of bed and postoperative hospital stay were recorded in the two groups. The adverse reactions of the two groups within 24 hours after operation were recorded. Results: Compared with the control group, the pain block time of the experimental group was significantly prolonged (P＜0.05) . Compared with the control group, the pain scores of the experimental group were significantly lower at 2-24 hours after operation (P＜0.05) . The use of ibuprofen suspension in the experimental group was significantly less than that in the control group (P＜0.05), and the use of tramadol was significantly lower than that in the control group (P＜0.05) . Compared with the control group, the time of getting out of bed in the experimental group was earlier (P＜0.05), and the postoperative hospital stay was shorter (P＜0.05) . There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05) . Conclusion: Dexamethasone combined with ropivacaine for BPB can provide good postoperative analgesic effect for children with supracondylar fracture of humerus, which is conducive to postoperative recovery. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to explore the effects of eye masks on the sleep quality and pain of children over 5 years old with humeral supracondylar fracture after surgery.MethodsFifty children with humeral supracondylar fracture who underwent closed reduction and percutaneous pinning (CRPP) in the Pediatric orthopaedic Department of a provincial hospital in China from February 2020 to December 2021 were selected. The children were randomly divided into the experimental group (n = 25) and the control group (n = 25). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights after surgery. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children’s Pain Behaviour Scale was used to evaluate the pain of the children.ResultsAfter three nights of receiving the eye mask intervention, the children in the experimental group had significantly lower sleep quality scores than those in the control group; the difference was statistically significant (p

Objective: To compare the therapeutic effects of different percutaneous Kirschner wire internal fixation in the treatment of Gartland type Ⅱ and Ⅲ supracondylar fractures of humerus. Methods: The clinical data of 90 children with Gartland type II and III supracondylar fractures of humerus who were treated in our hospital from March 2017 to March 2020 were retrospectively selected. According to different treatment methods, the children were divided into group A 47 cases (open reduction and percutaneous Kirschner wire internal fixation) and group B 43 cases (closed reduction and percutaneous Kirschner wire internal fixation). The curative effect, perioperative indexes and complication rate of the two groups were observed. Results: There was no significant difference in the excellent and good rate between group A and group B (P>0.05). The operation time, fracture healing time and hospital stay in group B were shorter than those in group A, and the intraoperative blood loss was less than that in group A, there were significant differences between groups (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: Whether closed reduction or open reduction and percutaneous Kirschner wire internal fixation are used in children with Gartland type Ⅱ and Ⅲ supracondylar humeral fractures, good surgical results can be obtained. Closed reduction has more advantages in shorten operation time, fracture healing time, hospital stay and reduce intraoperative blood loss. [ABSTRACT FROM AUTHOR]

Introduction: Due to increased number of trauma cases, several injuries in the same limb are not an uncommon entity now. Literature describes the floating elbow as a forearm fracture and supracondylar fracture of humerus in same extremity. Aim: The purpose of the study was to evaluate our experience in dealing with such uncommon injury. Materials and Methods: This is a prospective interventional study of floating elbow in younger age group. All the cases were managed by K-wire fixation and followed up to the average of 20 months. All the patients were followed by clinical and radiological mean. Functional score were obtained by Mayo Elbow Performance Score (MEPS) and Khalfayan score. Results: Results are based on 17 cases with average age of 9.58 years. The fracture healing was noticed at average of 9 weeks with average range of movement of 95 degree. Conclusion: Floating elbow is a serious injury. Injury type is out of the way and treatment recommendations are polemical. In our experience, this injury can be best treated by aggressive surgical intervention.

Introduction: Due to increased number of trauma cases, several injuries in the same limb are not an uncommon entity now. Literature describes the floating elbow as a forearm fracture and supracondylar fracture of humerus in same extremity. Aim: The purpose of the study was to evaluate our experience in dealing with such uncommon injury. Materials and Methods: This is a prospective interventional study of floating elbow in younger age group. All the cases were managed by K-wire fixation and followed up to the average of 20 months. All the patients were followed by clinical and radiological mean. Functional score were obtained by Mayo Elbow Performance Score (MEPS) and Khalfayan score. Results: Results are based on 17 cases with average age of 9.58 years. The fracture healing was noticed at average of 9 weeks with average range of movement of 95 degree. Conclusion: Floating elbow is a serious injury. Injury type is out of the way and treatment recommendations are polemical. In our experience, this injury can be best treated by aggressive surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the effects of eye masks on the sleep quality and pain of children over 5 years old with humeral supracondylar fracture after surgery., Methods: Fifty children with humeral supracondylar fracture who underwent closed reduction and percutaneous pinning (CRPP) in the Pediatric orthopaedic Department of a provincial hospital in China from February 2020 to December 2021 were selected. The children were randomly divided into the experimental group ( n  = 25) and the control group ( n  = 25). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights after surgery. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children's Pain Behaviour Scale was used to evaluate the pain of the children., Results: After three nights of receiving the eye mask intervention, the children in the experimental group had significantly lower sleep quality scores than those in the control group; the difference was statistically significant ( p  < 0.05), and the children in the experimental group had higher sleep quality. The experimental group's pain scores were significantly lower than the control group's, and the difference was statistically significant ( p  < 0.05), and the children in the experimental group experienced less post-operative pain., Conclusions: Eye masks are a simple, safe and economical intervention, that is beneficial for improving the sleep quality and reducing pain in children over 5 years old with humeral supracondylar fracture after closed reduction and percutaneous pinning. It can be used as a reference and basis for clinical pain relief and sleep quality after surgery for supracondylar fractures of the humerus in children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Wang, Lin, Xu, Chen and Cai.)

Introduction: Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim: This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods: This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results: In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. Conclusion: The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications.

To determine the relationship of delay in management of supracondylar fracture of humerus with reduced mobility of the joint. Methods: In this descriptive study patients with isolated fracture of supracondylar of humerus without any associated trauma, were included. They were classified into groups according to Gartlands’ classification based on antero-posterior and lateral view Xrays of the affected elbow joint. Patients were called for follow up 4,8 and 12 weeks after removal of backslab and Kirschner wires. Results: Mean age of presentation for fractures of supracondylar of humerus was 5.67±2.064 years with fracture occurring predominantly in males. Out of the 32 patients who sustained Gartland type III fractures, only 8(25%) patients were managed by closed reduction and internal fixation. In 28(75%) patients, open reduction and internal fixation had to be done. Mean delay time for treatment in type-I and type-II fractures was 2.86±2.25 and 2.56±1.42 days respectively. Gartland type-III injuries had a delay between injury and surgery of 4.88±2.95 days. Range of motion was more reduced in flexion angle as compared to extension, supination and pronation. Conclusion: An inverse relation was found between delay in presentation and range of motion. Increase in delay to seek optimal treatment is associated with a reduction in range of movement at the supracondyle of humerus. In Gartland type III fractures, open reduction had to be done to achieve satisfactory results in most of the patients who presented after a delay of more than 3 days. Follow up of the patients showed an improvement in mobility of the joint in the postoperative period but role of physiotherapy in achieving maximum mobility has not been determined yet

Introduction: Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim: This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods: This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results: In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. Conclusion: The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications. [ABSTRACT FROM AUTHOR]

Background: To determine the relationship of delay in management of supracondylar fracture of humerus with reduced mobility of the joint. Methods: In this descriptive study patients with isolated fracture of supracondylar of humerus without any associated trauma, were included. They were classified into groups according to Gartlands' classification based on antero-posterior and lateral view Xrays of the affected elbow joint. Patients were called for follow up 4,8 and 12 weeks after removal of backslab and Kirschner wires. Results: Mean age of presentation for fractures of supracondylar of humerus was 5.67±2.064 years with fracture occurring predominantly in males. Out of the 32 patients who sustained Gartland type III fractures, only 8(25%) patients were managed by closed reduction and internal fixation. In 28(75%) patients, open reduction and internal fixation had to be done. Mean delay time for treatment in type-I and type-II fractures was 2.86±2.25 and 2.56±1.42 days respectively. Gartland type-III injuries had a delay between injury and surgery of 4.88±2.95 days. Range of motion was more reduced in flexion angle as compared to extension, supination and pronation. Conclusion: An inverse relation was found between delay in presentation and range of motion. Increase in delay to seek optimal treatment is associated with a reduction in range of movement at the supracondyle of humerus. In Gartland type III fractures, open reduction had to be done to achieve satisfactory results in most of the patients who presented after a delay of more than 3 days. Follow up of the patients showed an improvement in mobility of the joint in the postoperative period but role of physiotherapy in achieving maximum mobility has not been determined yet. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the efficacy of compound ossotide injection combined with closed reduction and percutaneous kirschner wire fixation for supracondylar fracture of humerus. METHODS: 100 patients with supracondylar fracture of humerus admitted into Hubei Gucheng County People’s Hospital from 2016 to 2017 were retrospectively selected to be divided into observation group and control group via different treatment regimen, with 50 cases in each. Patients in the control group only received closed reduction and percutaneous Kirschner wire fixation, while the observation group were given compound ossotide injection on the basis of the control group. The elbow function, elbow mobility and quality of life scores of two groups were observed before and after treatment. RESULTS: After treatment, the excellent and good rate of elbow function of observation group was 76.00% (38/50), significantly higher than that of control group (56.00%, 28/50), the difference was statistically significant (P<0.05). After treatment, the angles of pre-rotation, supination, back extension and flexion of the elbow joint in observation group were significantly greater than those in control group, and the differences were statistically significant (P<0.05). After treatment and one month after treatment, the quality of life scores of two groups were significantly higher than before treatment, and the observation group was significantly higher than the control group, the differences were statistically significant (P<0.05). RESULTS: The efficacy of compound ossotide injection combined with closed reduction and percutaneous kirschner wire fixation for supracondylar fracture of humerus is significant, which can accelerate the recovery of patients and improve the quality of postoperative life. [ABSTRACT FROM AUTHOR]

Early treatment planning for supracondylar fracture of humerus (SFHs) in children by image processing research is mainly focus on developing a complete software solution for analysis and diagnosis of SFHs in children as well as provides a pre operational planning is the main objective of this study. However, as the manual process of measurement is usually complex, it is difficult to operate on clinic. This study proposes an effective technique for measuring a fracture angle in digital scan images taken on the personal computer. This approach is particularly promising in the context of find the angle of the fracture because of the high level of children needed in such accuracy in calculation of the fracture angle to fix it. Our goal is accurate detection of fracture angle. In this paper, we present a strategy based on advances in automatic interpretation of images applied to X-ray images scanned in situ. We propose a cognitive vision system that combines image processing, learning and knowledge based techniques with an advance algorithm to solve the problem. This system is illustrated with automatic detection and calculating Cubitus varus deformity at an early stage. We have compared our approach with manual calculation methods and our results showed that automatic processing is reliable. Special attention was paid to high fracture cases, which are crucial to take decisions whether to treat with an operation. The proposed method was validated with the results showing with the manual calculation and an operator can successfully make a measurement within a minute. [ABSTRACT FROM AUTHOR]

Objective: To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers., Methods: A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected., Results: There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P >0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t =0.480, P =0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t =0.789, P =0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t =1.143, P =0.262; t =0.587, P =0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%., Conclusion: Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.

The simultaneous occurrence of ipsilateral humeral supracondylar, forearm and wrist fractures is an uncommon injury. This fracture pattern is very difficult to treat, but no detailed cases were found in the English literature. A case of this unusual combination in a teenager is reported, successfully managed by open reduction and Kirschner wire (K–wire) fixation of the elbow fracture with open reduction of the forearm fractures and fixation with long intramedullary K–wires. [ABSTRACT FROM AUTHOR]