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LETTER TO EDITOR  
Year : 2016  |  Volume : 50  |  Issue : 4  |  Page : 447
Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning


Bone and Joint Hospital, Barzulla GMC, Srinagar, Jammu and Kashmir, India

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Date of Web Publication6-Jul-2016
 

How to cite this article:
Tantray MD. Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning. Indian J Orthop 2016;50:447

How to cite this URL:
Tantray MD. Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning. Indian J Orthop [serial online] 2016 [cited 2019 Dec 7];50:447. Available from: http://www.ijoonline.com/text.asp?2016/50/4/447/185621
Sir,

I read with interest the article by Sharma et al. [1] titled as "Early results of displaced supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning." The authors have introduced the novel lateral trans-olecranon pinning technique for displaced supracondylar fracture of the humerus which is quiet appreciable. I would like to discuss some issues related to this article.

Although in both lateral pinning technique and lateral trans-olecranon pin groups, satisfactory results were obtained in 90% cases. In lateral trans-olecranon pinning technique, the elbow is fixed in 90° of flexion which might not be feasible in massive swelling of the elbow, impending compartment syndrome and pulseless hand. It must be emphasized that flexion of the elbow of 90° or more with a type III supracondylar fracture significantly increases the risk of compartment syndrome and should rarely, if ever, be done if modern operative facilities and an experienced surgeon are available. [2]

The author has not mentioned the type of fixation used in the patients who had the massive swelling of the elbow and the patients with a feeble radial pulse with adequate perfusion. Even if a distal pulse is found by palpation or Doppler examination, an evolving compartment syndrome may be present. [3]

Although open fractures, Gustilo-Anderson grade II and III, an irreducible fracture or fracture with vascular injury having a pulseless arm with poor perfusion were excluded from the study. The author has not mentioned such type of fractures as a possible limitation to lateral-trans-olecranon pinning technique.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sharma A, Walia JP, Brar BS, Sethi S. Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning. Indian J Orthop 2015;49:529-35.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Battaglia TC, Armstrong DG, Schwend RM. Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop 2002;22:431-9.  Back to cited text no. 2
[PUBMED]    
3.
Ramachandran M, Birch R, Eastwood DM. Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: The experience of a specialist referral centre. J Bone Joint Surg Br 2006;88:90-4.  Back to cited text no. 3
[PUBMED]    

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Correspondence Address:
Mehraj Din Tantray
Bone and Joint Hospital, Barzulla GMC, Srinagar - 190 001, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.185621

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