| Objective: 1.To compare the clinical results of Gartland type Ⅲ and Gartland type Ⅳsupracondylar fractures of humerus in children treated with closed reduction and percutaneous pinning(CRPP).The Gartland type IV fracture was demonstrated to be more difficult to treat due to the greater severity of the injury.2.Do a retrospective analysis about using a capitellum pin joystick technique assisted CRPP in the teatment of Gartland type IV supracondylar humeral fractures in children.3.To study the biomechanical stability of two different fixation methods of Kirschner wire by using children’s cadaver specimens to provide experimental basis for the treatment of supracondylar fracture of humerus in children.Methods: This study is divided into two parts: clinical retrospective analysis and biomechanical experiment.The specific methods are as follows:1.Collect the clinical data of Gartland type III fracture patients who were treated in the Children’s Orthopedic Medical Center of the Second Affiliated Hospital of Inner Mongolia Medical University from 2020.1to 2021.1 and Gartland type IV fracture patients who were treated in the center from 2015.1 to2022.1.It was divided into three groups: 117 patients with Gartland type III fracture treated directly by CRPP were divided into group A,31 patients with Gartland type IV fracture treated directly by CRPP were divided into group B,and 20 patients with Gartland type IV fracture treated by CRPP assisted by capitellum pin joystick technique were divided into group C.The main outcome measures were age,sex,height,weight,injured side,operation duration,fluoroscopy times,Baumann angle,Carrying angle,lateral capitellohumeral angle,range of motion of elbow joint,criteria of Flynn,and postoperative complications.Statistical analysis of the above indicators.Select 8 cadaver specimens of children with an average age of2.6 years(4 to 1 years)who have been embalmed with formalin,structuring 16 models of supracondylar fracture of humerus.Using three lateral divergent pins and Dorgan’s crossed pins fix the fracture model.Examining the loads corresponding to different tensile displacements and torque corresponding to different angles by means of biomechanical instruments for the two fixations.The biomechanical characteristics of the two modes of fixation were compared,and statistical analysis was performed.Results: 1.In the clinical retrospective analysis research section,there were no significant statistical differences among the three groups in the distribution of age,sex,height,weight,and injured side.The operative time 19.50±5.95 min and fluoroscopy number 19.76±7.13 times in group A were significantly less compared with 46.84±12.87 min and 48.61±19.36 times in group B,which were statistically significant(P <0.05).The immediate postoperative Baumann angle and carrying angle were 71.16±1.72°and 13.03±2.26°in group A,77.01±1.94°and 10.73±1.23°in group B;The Baumann angle and carrier angle at the last follow-up were 70.94± 1.55°and 13.24±2.11°in group A,77.36±2.11°and 10.70±1.34°in group B,with significant differences(P<0.05),the quality of reduction on the anteroposterior radiographic view was significantly better for patients in group A than that of group B.All cases showed restoration of the normal lateral capitellohumeral angle.Elbow range of motion143.13±5.71°in group A compared with 140.98±3.67°in group B at last follow-up(P<0.05).The infection rate and the criteria of Flynn were 4.27% and 94.02%,respectively,in group A,and 6.45% and 90.32%,respectively,in group B,with no statistical difference between the two groups.2.The operative time of 46.84±12.87 min and fluoroscopy number of48.61±19.36 times in group B were more than those of 28.15±8.37 min and 25.55±8.38 times in group C,with significant differences between the two groups(P<0.05).The immediate postoperative Baumann angle and carrying angle were 77.01±1.94°and 10.73±1.23°in group B,73.27±2.60°and 12.73±0.92°in group C;The Baumann angle and carrier angle at the last follow-up were 77.36±2.11°and 10.70±1.34°in group B,72.49±2.44°and 12.82±0.87°in group B,with significant differences(P<0.05),the quality of reduction on the anteroposterior radiographic view was significantly better for patients in group C than that of group B.All cases showed restoration of the normal lateral capitellohumeral angle.The elbow range of motion in group B was 140.98±3.67°,infection rate was 6.45%,and the elbow joint function of excellent and good rate of the criteria of Flynn was 90.32%,group C was 142.08±2.77°,0,95.00%,respectively at the last follow-up,with no significant statistical difference between the two groups.3.The operative time 19.50±5.95 min and fluoroscopy number 19.76±7.13 times in group A were significantly less compared with 28.15±8.37 min and 25.55±8.38 times in group C,which were statistically significant(P<0.05).4.In biomechanics experimental section,tensile experiments at 0.5 mm,1.0 mm,1.5 mm,and 2.0 mm displacements,the loads of the Dorgan’s crossed pins group were 22.76±1.26 N,47.09±0.47 N,66.61±1.41 N,85.96±3.25 N,and the three lateral divergent pins group had a loading of 16.82±3.22 N,32.60±4.60 N,44.71±4.40 N,58.56±9.15 N,the difference between the two groups was statistically significant.Torsional experiments at 10°,20°,30°angles,the torque of the Dorgan’s crossed pins group were 0.47±0.09 N.m,0.67±0.10 N.m,0.84±0.15 N.m,and the three lateral divergent pins group had a torquing of 0.21±0.11 N.m,0.37±0.10 N.m,0.50±0.11 N.m,the difference between the two groups was statistically significant.Conclusion: 1.Gartland type IV fractures are more difficult to treat than Gartland type III fractures.2.Compared with CRPP alone,joystick-assisted CRPP in the treatment of Gartland type IV fracture can effectively control the instability of the distal fracture,and has the characteristics of high efficiency,safety and accurate reduction.3.The Dorgan’s crossed pins placement regime was more stable in longitudinal extension and axial rotation than the three lateral divergent pins. |
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