Abstract
Purpose: To eliminate iatrogenic Ulnar Nerve injury.
Methods: We prospectively reviewed 25 consecutive paediatric gartland’s type 3 supracondylar fractures with a minimum follow-up of 1 yr operated by our novel technique. Good reduction was achieved with closed reduction in 20 and 5 cases warranted an open reduction. Our technique involved passage of two percutaneous 1.6 mm smooth K-wires supero-medially from lateral condyle across the fracture site to obtain a purchase in upper medial cortex of proximal fragment. A third K-wire was passed percutaneously from lateral supracondylar pillar proximal to the fracture site in infero-medial direction to gain purchase in distal fragment’s subchondral bone of medial condyle thus creating a cross construct. Care was taken not to breach the subchondral bone so as to avoid ulnar nerve injury. All patients were operated in supine position under general anaesthesia and lateral collateral approach was used with same K-wire construct in cases that needed open reduction. Stability was checked post-operatively by rotation under real time imaging. The mean age of patients was 6.8 yrs. The mean time from sustaining the fracture to operative pinning was 24 hrs. An above elbow immobilisation backslab was applied for 3 weeks. The K-wires were removed at 3 and 4 weeks in cases that had closed and open reduction respectively and active assisted movements were initiated. All patients were followed up at 1/52, 3/52, 6/52, 3/12, 6/12 and 1 year post-operatively.
Results: Flynn’s criterion was used for post-op functional evaluation. 20 cases had excellent and 5 had good outcome at end of 1 year. There was no case of nerve palsy (superficial radian or ulnar N), pin-tract infection, loss of reduction or late cubitus varus/valgus or hyper-extension deformities.
Conclusion: Our innovative technique is an excellent alternative option without compromising on fracture stability in the treatment of these fractures.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
