Indian Journal of Orthopaedics

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


Mehraj Din Tantray 
 Bone and Joint Hospital, Barzulla GMC, Srinagar, Jammu and Kashmir, India

Correspondence Address:
Mehraj Din Tantray
Bone and Joint Hospital, Barzulla GMC, Srinagar - 190 001, Jammu and Kashmir
India




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;50:447-447


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 2020 Feb 26 ];50:447-447
Available from: http://www.ijoonline.com/text.asp?2016/50/4/447/185621


Full Text

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sharma 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.
2Battaglia 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.
3Ramachandran 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.