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The Use of a Transolecranon Pin in the Treatment of Pediatric Flexion-type Supracondylar Humerus Fractures

Green, Brandon M. DO*; Stone, Joseph D. MD; Bruce, Robert W. Jr MD*; Fletcher, Nicholas D. MD*

Journal of Pediatric Orthopaedics: September 2017 - Volume 37 - Issue 6 - p e347–e352
doi: 10.1097/BPO.0000000000000904
Trauma
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Background: Flexion-type supracondylar humerus fractures are much more uncommon than their extension-type counterparts. Instability in elbow flexion renders traditional closed techniques inadequate and often results in the need for open reduction. We present a simple technique for closed reduction using a transolecranon pin for temporary stability.

Methods: A retrospective review of 9 patients treated with a transolecranon pin technique for a flexion-type supracondylar humerus fracture was performed. Operative time, need for open reduction, postoperative range of motion, final radiographic alignment using Baumann angle, and the intersection of the anterior humeral line with the capitellum was evaluated.

Results: All 9 patients were treated with closed reduction using a temporary transolecranon pin technique. Total surgical time averaged 38±15 minutes and was longer for type III than type II flexion-type fractures. All fractures healed by first follow-up at 1 month. There was 1 preoperative ulnar nerve deficit that resolved by the first postoperative visit. Average Baumann angle at radiographic healing was 71.2±3.3 degrees and all cases showed restoration of the normal anterior humeral line:capitellar relationship. Average postoperative flexion at final follow-up was 125 degrees and extension was 5 degrees. One patient had a flexion contracture of 10 degrees.

Discussion: Use of a temporary transolecranon pin allowed for closed reduction of all flexion-type fractures with no radiographic malunion. This technique is technically simple and avoids the need for open reduction or multiple fluoroscopy views.

Level of Evidence: Level IV—case series.

*Department of Orthopaedics, Emory University

Pediatric Orthopaedic Associates, Atlanta, GA

No internal or external support was received for this study.

There was no funding used for this study from the NIH, HHMI, or other sources.

The authors declare no conflicts of interest.

Reprints: Nicholas D. Fletcher, MD, Department of Orthopaedics, Emory University, 59 Executive Park South NE, Atlanta, GA 30329. E-mail: nicholas.d.fletcher@emory.edu.

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