title: Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation.
abstract: OBJECTIVE
  Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.
  
  
  METHODS
  We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type III) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.
  
  
  RESULTS
  Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria, 38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.
  
  
  CONCLUSIONS
  Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India. dramandua@gmail.com
authors.forename: Aman
authors.initials: A
authors.lastname: Dua
authors.forename: Krishna Kiran
authors.initials: KK
authors.lastname: Eachempati
authors.forename: Rajesh
authors.initials: R
authors.lastname: Malhotra
authors.forename: Lalit
authors.initials: L
authors.lastname: Sharma
authors.forename: Mallinath
authors.initials: M
authors.lastname: Gidaganti
mesh_terms: D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D011446:Prospective Studies