A Novel

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A Novel Innovative technique of pin passage
construct in treatment of Gartlands Type III
Supracondylar Fractures in Children

• Mr. Harshavardhana NS
• Dr. Pilankar SP
• Dr. Patil NK
• Dr. Bagaria VB
• Dr. Sapre VR
• Dr. Lambat MG
• Prof. Karkhanis AR
• Mr. Bharadwaj RG
• Mr. Sahu A

• Seth G S Medical College, Univ of Mumbai INDIA

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BACKGROUND

• Gold Standard Rx - Closed Reduction Percut
  Crossed K-wires (Wilkins KE, Busch
  MT, Aronson DD, Boyd DW, Pirone AM et al)
• Medial Pin Placement Ulnar N Neuropraxia (3-5)
• Ulnar N Palsies after percutaneopus
  pining of Supracondylar res in Paed elbow.
  Lybis et al J Paed Orthop 1998 18 43
• Neurologic complicatins after K-wire
  fixation of supracondular res in children.
  Royce et al J Paed Orthop 1991 1 191
• Alternative Lateral Pin constructs
  (biomechanically less stable than cross
  K-wires)

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MATERIALS METHODS

• Prospective study of 19 cases of Gartlands
  extension type III res.
• Types I II res were excluded in this study.
• Close reduction and pinning in 16 cases.
• Open reduction required in 3 cases.
• Approach used for open reduction -- LATERAL.

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MATERIALS METHODS

• Av Age 7.1 yrs (3 11)
• Av time from Injury to Sx 25.7 hrs (12
  100)
• Av F/u for 11 wks (9 - 25)
• Wires removed at 3 wks (closed pinning) 5 wks
  (ORIF cases)

(X axis Age Group Y axis No of Patients)
Right extremity 12 Left extremity 7 cases
respectively
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Our Novel INNOVATIVE Technique

• Confirm reduction under Image Intensifier (rotate
  the C-arm and NOT the patients arm)
• Two 1.6 mm K-wires passed from lateral condyle
  upwards at le of 300 to humeral axis to secure
  purchase in medial cortex.
• Third K-wire passed (under image intensifier
  guidance) from Lateral Supracondylar pillar
  downwards to gain purchase in medial subchondral
  bone of Distal Fragment.
• CARE TAKEN NOT TO BREACH THE SUBCHONDRAL BONE to
  avoid ULNAR N Injury.

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PRE-OP RADIOGRAPHS
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POST-OP RADIOGRAPHS
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RESULTS

• Assessment based on Flynns Criteria as it takes
  into account
• Loss of Range of Motion (ROM)
• Loss of Carrying Angle

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DISCUSSION CONCLUSION

• Studies Re - Optimal Pin Construct
• Torsional strength of pin configurations used to
  fix SC Humeral res Zionts LE et
  al, JBJS(A) 1994 76(2) 253-6.
• Biomechanical analysis of Percutaneous
  pinning techniques
  Lee SS et al, J Paed Orthop 2002 (22)
  440-3.
• Our Innovative concept is -- SAFE
• 
  SIMPLE
• 
  STABLE
• 
  COMPARABLE to GOLD Standard.
• Limitations of our Study are
• -- Needs Biomechanical Evidence
• -- Needs long term
  Follow-up Re Loss of Carrying angle resulting
  in Cubitus Varus / Hyperextension deformities.

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A Mind that knows the Principles will
..And Finally
Devise its own Methods
Thank you