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 Table of Contents    
LETTER TO EDITOR  
Year : 2016  |  Volume : 50  |  Issue : 4  |  Page : 448
Author's reply


Department of Othopaedics, Government Medical College and Rajindra Hospital, Patiala, Punjab, India

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Date of Web Publication6-Jul-2016
 

How to cite this article:
Walia JP, Brar BS, Sharma A, Sethi S. Author's reply. Indian J Orthop 2016;50:448

How to cite this URL:
Walia JP, Brar BS, Sharma A, Sethi S. Author's reply. Indian J Orthop [serial online] 2016 [cited 2019 Dec 12];50:448. Available from: http://www.ijoonline.com/text.asp?2016/50/4/448/185624
Sir,

We thank Dr. Mehraj Din Tantray [1] for showing a keen interest in our article titled as "Early results of displaced supracondylar fractures of humerus in children treated by closed reduction and percutaneous pinning. [2]"

We agree with Dr. Tantray on the fact 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 be done. Rather the authors also refrain from giving flexion of 90° or more at the elbow after fixing a supracondylar fracture with either the transolecranon or the lateral pinning technique in patients with massive swelling and this does not cause any difficulty in insertion of the transolecranon wire. Thus, the lateral-transolecranon technique can be used in Grade III supracondylar fractures with massive swelling.

In fact, in the transolecranon technique, the lateral entry wire was first inserted so that once the fracture was somewhat stabilized, the elbow may be extended to beyond 90° and then the transolecranon wire was inserted. Had the transolecranon K-wire been inserted before the lateral entry wire, the former would not have allowed much extension at the elbow.

A key point to remember in the transolecranon technique is that after inserting the lateral entry K-wire in full flexion, the elbow is extended to beyond 90° and the transolecranon wire inserted. However, once the transolecranon wire has been inserted, the elbow should be maintained in the same position of flexion, even while applying the plaster of paris splint. Otherwise, movement of the elbow can cause bending or even breakage of this K-wire.

We excluded open fractures, Gustilo-Anderson grade II and III, an irreducible fracture or fracture with vascular injury having a pulseless arm with poor perfusion from the study as an open reduction is mandatory in such cases with vascular repair. However, the study was undertaken for closed treatment of supracondylar fractures in children. This does not conclude that the aforementioned cases are a possible limitation to a lateral transolecranon pinning technique which can very well be utilized like any other technique for open reduction and internal fixation.

 
   References Top

1.
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.  Back to cited text no. 1
  Medknow Journal  
2.
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. 2
[PUBMED]  Medknow Journal  

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Correspondence Address:
Anmol Sharma
5728, Modern Housing Complex, Manimajra, Chandigarh (U.T.) - 160 101
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.185624

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