“DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES STUDY AND RESEARCH GROUP IN TRAUMA AND PEDIATRIC ORTHOPAEDICS – CONSTANȚA 2021
Main Article Content
Abstract
Background Context. The presence of special, rare and various forms which we can encounter when treating supracondylar humeral fractures (SHF) in children, call into question what therapeutic methods can be used to increase the effectiveness of the treatment applied. The aim of this paper is to present the results obtained by using double cross-fixation, "in double X", by closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) in treating rare and particular forms. Comments and opinions on "double X" method and other cross or side configurations are presented.
Patient Sample. All patients with rare and particular forms presented in this article, were operated during 2001-2020 in state and private hospitals. Fixation in "double X" was used either by CRPP and ORIF. The epitrochlear approach (EA) was performed in cases where stability by CRPP could not be ensured or when there were clear signs of ulnar nerve damage. The minimal medial-approach (mMA) highlights the epitrochlea and the fracture of the medial pylon; it has the role of anatomically reducing the medial pylon, thinner and very unstable in rare and particular forms. During 1982-2020 we consulted, treated and evaluated patients with SHF to whom all known treatment methods were applied: orthopedic reduction and immobilization in plaster cast, CRPP, ORIF, minimal-open reduction and internal fixation (mORIF) by mMA and external fixator. Internal fixation was done by the techniques of Judet, San Antonio, San Diego, Dorgan, in “X” and “double X”. In 2001, I introduced "double X" fixation to better stabilize anatomical reductions that showed signs of instability during intraoperative verification.
All indications given in the study protocol have been made in accordance with the regulations mentioned in the experimental program.
Results. All SHFs operated by CRPP and ORIF by “double X” were cured and satisfactory and good results were obtained in the neglected types operated between 14 and 60 days and good and excellent results were obtained in the rare forms.
Conclusions. “Double X” fixation gives the best stabilization and postoperatively there is no need for immobilization in a plaster cast. Recovery may begin the day after surgery.
Keywords: supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days.
Keywords:
supracondylar fractures, child elbow pathology, cross-fixation, lateral fixation, healing and recovery after 30-45 days
Article Details
How to Cite
BURNEI, Gheorghe et al.
“DOUBLE X” FIXATION FOR RARE AND PARTICULAR PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES.
Medical Research Archives, [S.l.], v. 9, n. 6, june 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2411>. Date accessed: 03 july 2024.
doi: https://doi.org/10.18103/mra.v9i6.2411.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Camp J, Ishizue K, Gomez M, Gelberman R, Akeson W. Alteration of Baumann’s angle by humeral position: implications for treatment of supracondylar humerus fractures. J Pediatr Orthop. 1993;13(4):521–25;
2. Tuomilehto N, Kivisaari R, Sommarhem A, Nietosvaara AY. Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary. Acta Orthop. 2017;88(1):109-15;
3. Gamble JG, Vorhies JS. Remodeling of Sagittal Plane Malunion after Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(10):e903-9;
4. Lewine E, Kim JM, Miller PE, Waters PM, Mahan ST, Snyder B, Hedequist D, Bae DS. Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results. Journal of Pediatric Orthopaedics. 2018;38(2):77-81;
5. Sharma A. The Flexion-Type Supracondylar Humeral Fracture in Children. JBJS. 2019;7(4):e6;
6. Mitchell SL, Sullivan BT, Ho CA, Abzug JM, Raad M, Sponseller PD. Pediatric Gartland Type - IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. The Journal of Bone and Joint Surgery. 2019;101(15):1351-6;
7. Abzug JM, Ho CA, Ritzman TF, Brighton BK. Transphyseal Fracture of the Distal Humerus. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(2):e39-44;
8. Li D, Sun D, Wang J. The Experience of Open Reduction, Internal Fixation and Plaster Immobilization in Supracondylar Extension Fractures with Low Position. Chinese Journal of Bone and Joint Injury. 2011;26(5):463-64;
9. Popkin CA, Rosenwasser KA, Ellis HB Jr. Pediatric and Adolescent T-type Distal Humerus Fractures. J Am Acad Orthop Surg Glob Res Rev. 2017 Nov 1;1(8):e040;
10. Anari JB, Neuwirth AL, Carducci NM, Donegan DJ, Baldwin KD. Pediatric T-Condylar Humerus Fractures: A Systematic Review. Journal of Pediatric Orthopaedics. 2017;37(1):36-40;
11. Tomori Y, Sudo Y, Iizawa N, Nanno M, Takai SM. Intercondylar Fracture of the Distal Humerus in A 7-Year-Old Child; A Case Report and a Review of the Literature. Medicine. 2017;96:6;
12. Blumberg TJ, Bremjit P, Bompadre V, Steinman S. Forearm Fixation is Not Necessary in the Treatment of Pediatric Floating Elbow. Journal of Pediatric Orthopaedics. 2018;38(2):82-7;
13. Rehm A, Thahir A. Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2019;22, Letter to the editor, doi:10.1097/BPO.0000000000001478;
14. Li NY, Bruce WJ, Joyce C, Decker NM, Cappello T. Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2018;38(3):e118-21;
15. Hsiao CPT, Mark SMD, Mormino MA, Esposito PW, Burke BA. Distal Humerus Atrophic Nonunion in a Child with Osteogenesis Imperfecta. Journal of Pediatrics. 2013;33(7):725-9;
16. Guo M, Xie Y, Su Y. Open Reduction of Neglected Supracondylar Humeral Fractures with Callus Formation in Children. Journal of Pediatric Orthopaedics. 2020;40(8):e703-7;
17. Gómez VE, Gil Albarova J, Herrera A. Review and Update of the Treatment of Supracondylar Humerus Fractures in Childhood. Rev Esp Cir Osteoar. 2013;48(255):110-22;
18. Bănculescu M. quoted by: Burnei G, Burnei C, Enache FD, Daraban AM, Răducan ID. “Double X” Cross Fixation in Paediatric Supracondylar Humerus Fractures: A 20-Year Expertise and 94 Surgical Interventions. Annals of Clinical and Medical Case Reports. 2020; V5(6): 1-12;
19. Gil Albarova J, Bregante J, De Pablos J. Secondary Deformities of The Elbow in Children. En: Surgical Techniques in Orthopaedics and Traumatology, 55-260-D-50. Paris: Elsevier SAS;2004;1-6;
20. Wilkins KE, Beaty JH, Chambers HG, Toniolo RM. Fractures and Dislocations of the Elbow Region. In: Rockwood CA, Wilkins KE, Beaty JH, editors. Fractures in Children. 4th ed. Philadelphia: Lippincott-Raven; 1996. pp. 653–752;
21. Noonan KJ, Jones JW. Recurrent Supracondylar Humerus Fracture Following Prior Malunion. Iowa Orthop J. 2001;21:8–12;
22. Takahara M, Sasaki I, Kimura T, Kato H, Minami A, Ogino T. Second Fracture of the Distal Humerus after Varus Malunion of a Supracondylar Fracture in Children. Journal of Bone and Joint Surgery. 1988;80- B(5):791–797;
23. Nork SE, Hennrikus WL, Loncarich DP, Gillingham BL, Lapinsky AS. Relationship between Ligamentous Laxity and the Site of the Upper Extremity Fractures in Children: Extension Supracondylar Fracture Versus Distal Forearm Fracture. Journal of Pediatric Orthopaedics. 1999;8(2)PartB:90–2;
24. Anari JB, Arkader A, Spiegel DA, Baldwin KD. Approaching Unusual Pediatric Distal Humerus Fracture Patterns. Journal of the American Academy of Orthopaedic Surgeons. 2019;27(9):301-11;
25. Gómez VE, Gil Albarova J, Herrera A. Complications in supracondylar humerus fractures in childhood. Rev Esp Cir Osteoar. 2013;48(256):150-62;
26. Hussain S, Ahmad M, Muzaffar T. Open Reduction and Internal Fixation for Displaced Supracondylar Fractures of the Humerus in Children with Crossed K-Wires Via Lateral Approach. Chin J Traumatol. 2014;17(3):130-5;
27. Ipolito E, Moneta MR, D'Arrigo C. Post-Traumatic Cubitus Varus. Long-Term Follow-up of Corrective Supracondylar Humeral Osteotomy in Children. J Bone Joint Surg Am. 1990;72(5):757-65;
28. Kasse AN, Limam SA, Diao S, Lo FB, Sane ZC, Ady MH. Lateral Closed Wedge Ostetomy and Cross Pinning for the Treatment of Post-Traumatic Cubitus Varus Deformity. Rev int sc med (RISM) 2017;19(4)supplem:402-7;
29. Ojeaga P, Wyatt CW, Wilson P, Ho CA, Copley LAB, Ellis HB Jr. Pediatric Type II Supracondylar Humerus Fractures: Factors Associated with Successful Closed Reduction and Immobilization. Journal of Pediatric Orthopaedics. 2020;40(8):e690-6;
30. De Pablos J, Gil Albarova J, González J. Trauma to the shoulder girdle and upper limb. In: De Pablos J, González P. Child fractures. Concepts and principles. 2nd Ed. Oviedo: Prisma Cabinet of Design, 2005;
31. Mubarak CJ, Wallace CD. Complications of Supracondylar Elbow Fractures. In: Morrey BF. Traumatology of the Elbow. 3rd Ed. Madrid, Marban, 2004;
32. Ponce BA, Hedequist DJ, Zurakowski D, Atkinson CC, Waters PM. Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures. J Pediatr Orthop. 2004;24(6):610-14;
33. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative Treatment of Supracondylar Fractures of the Humerus in Children. The Consequences of Pin Placement. J Bone Joint Surg Am. 2001;83(5):735-40;
34. Ladenhauf HN, Schaffert M, Bauer J. The Displaced Supracondylar Humerus Fracture: Indications for Surgery and Surgical Options: A 2014 Update. Curr Opin Pediatr. 2014;26(1):64-9;
35. Eguia F, Gottlich C, Lobaton G, Vora M, Sponseller PD, Lee R, Jay M. Mid-term Patient-reported Outcomes After Lateral Versus Crossed Pinning of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(7):323-8;
36. Flynn JC, Matthews JG, Benoit RL. Blind Pinning of Displaced Supracondylar Fractures of the Humerus in Children: Sixteen Years’ Experience with Long-Term Follow-Up. J Bone Joint Surg Am. 1974;56(2):263–72;
37. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How Safe is the Operative Treatment of Gartland Type II Supracondylar Humerus Fractures in Children? J Pediatr Orthop. 2008;28(2):139-41;
38. Kumar V, Singh A. Fracture Supracondylar Humerus: A Review. J Clin Diagn Res. 2016;10(12):1–6;
39. Kim TJ, Sponseller PD. Pediatric Supracondylar Humerus Fractures. J Hand Surg Am. 2014;39(11):2308-11;
40. Abott MD, Buchler L, Loder RT, Caltoum CB. Gartland Type III Supracondylar Humerus Fractures: Outcome and Complications as Related to Operative Timing and Pin Configuration. J Child Orth op. 2014;8(6): 473-7;
41. Kavak US, Yüce A, Koçak N, Demir H, Saltik İN, Gürakan F, Özen H. Bone Mineral Density in Children with Untreated and Treated Celiac Disease. Journal of Pediatric Gastroenterology and Nutrition: 2003;37(4):434-36;
42. Molina Mata M. Thesis: Complications of Supracondylar Humerus Fractures in Childhood. 2014-2015;3-25, Academic Course, Zaragoza University, Faculty of Medicine. Tutor: Dr. Jorge Gil Albarova. Service of Orthopedic Surgery and Traumatology, Zaragoza University Hospital;
43. Wilkins KE. Supracondylar Fractures of the Distal Humerus. En: Rockwood CA, Wilkins KE, Besty JH, Kasser RK, eds. Fractures in children. 5th ed. Philadelphia: JB Lippincott; 2007. p. 577-624;
44. American Academy of Orthopaedic Surgeons. Guideline on the Treatment of Pediatric Supracondylar Humerus Fractures 2011. http://www.aaos.org/Research/guidelines/SupracondylarFracture/SupracondylarFracture/Guideli ne.asp. Retrieved 19 December 2011;
45. Biyani A, Gupta SP, Sharma JC: Determination of Medial Epicondylar Epiphyseal Angle for Supracondylar Humeral Fractures in Children. J Pediatr Orthop 1993;13:94-7;
46. Tomori Y, Nanno M, Takai S. Clinical Results of Closed Versus Minimal-Open Reduction with Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children. Medicine (Baltimore). 2018;97(45):e13162;
47. Green DW, Widmann RF, Frank JS, Gardner MJ. Low Incidence of Ulnar Nerve Injury with Crossed Pin Placement for Pediatric Supracondylar Humerus Fractures Using a Minimal-open Technique. J Orthop Trauma. 2005;19(3):158-163;
48. Mulpuri K, Tritt BL. Low Incidence of Ulnar Nerve Injury with Crossed Pin Placement for Pediatric Supracondylar Humerus Fractures Using a Minimal-open Technique. J Orthop Trauma. 2006;20(3):234;
49. Iobst CA, Bunhor D, Skaggs DL, Frick SL. Intra-Operative Bone Stability Test. Tech Orthop. 2018;33(4):279-82;
50. Thompson RM, Hubbard EW, Elliott M, Riccio AI, Sucato DJ. Is Less More? Assessing the Utility of Early Clinical and Radiographic Follow-up for Operative Supracondylar Humerus Fractures. J Child Orthop. 2018;12(5):502-8;
51. Takagi T, Takayama S, Nakamura T, Horiuchi Y, Toyama Y, Ikegami H. Supracondylar Osteotomy of the Humerus to Correct Cubitus Varus: Do Both Internal Rotation and Extension Deformities Need to Be Corrected? J Bone Joint Surg (Am). 2010;92:1619-26;
52. Mehserle WL, Meehan PL. Treatment of the Displaced Supracondylar Fracture of the Humerus (Type III) with Closed Reduction and Percutaneous Cross-Pin Fixation. Journal of Pediatric Orthopaedics. 1991 11(6):705-11;
53. Silva M, Day MJ, Aceves-Martin B, Ebramzadeh E. Sagittal Plane Residual Deformity in Pediatric Type II Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(7):e547-53;
54. Burnei G. et al. Double X Osteosynthesis in Humeral Supracondylar Fractures with Malunion and Joint Stiffness Risks. 32nd EPOS Annual Meeting; 17-20 of April 2013; Athens, Greece.
2. Tuomilehto N, Kivisaari R, Sommarhem A, Nietosvaara AY. Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary. Acta Orthop. 2017;88(1):109-15;
3. Gamble JG, Vorhies JS. Remodeling of Sagittal Plane Malunion after Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(10):e903-9;
4. Lewine E, Kim JM, Miller PE, Waters PM, Mahan ST, Snyder B, Hedequist D, Bae DS. Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results. Journal of Pediatric Orthopaedics. 2018;38(2):77-81;
5. Sharma A. The Flexion-Type Supracondylar Humeral Fracture in Children. JBJS. 2019;7(4):e6;
6. Mitchell SL, Sullivan BT, Ho CA, Abzug JM, Raad M, Sponseller PD. Pediatric Gartland Type - IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. The Journal of Bone and Joint Surgery. 2019;101(15):1351-6;
7. Abzug JM, Ho CA, Ritzman TF, Brighton BK. Transphyseal Fracture of the Distal Humerus. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(2):e39-44;
8. Li D, Sun D, Wang J. The Experience of Open Reduction, Internal Fixation and Plaster Immobilization in Supracondylar Extension Fractures with Low Position. Chinese Journal of Bone and Joint Injury. 2011;26(5):463-64;
9. Popkin CA, Rosenwasser KA, Ellis HB Jr. Pediatric and Adolescent T-type Distal Humerus Fractures. J Am Acad Orthop Surg Glob Res Rev. 2017 Nov 1;1(8):e040;
10. Anari JB, Neuwirth AL, Carducci NM, Donegan DJ, Baldwin KD. Pediatric T-Condylar Humerus Fractures: A Systematic Review. Journal of Pediatric Orthopaedics. 2017;37(1):36-40;
11. Tomori Y, Sudo Y, Iizawa N, Nanno M, Takai SM. Intercondylar Fracture of the Distal Humerus in A 7-Year-Old Child; A Case Report and a Review of the Literature. Medicine. 2017;96:6;
12. Blumberg TJ, Bremjit P, Bompadre V, Steinman S. Forearm Fixation is Not Necessary in the Treatment of Pediatric Floating Elbow. Journal of Pediatric Orthopaedics. 2018;38(2):82-7;
13. Rehm A, Thahir A. Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2019;22, Letter to the editor, doi:10.1097/BPO.0000000000001478;
14. Li NY, Bruce WJ, Joyce C, Decker NM, Cappello T. Obesity’s Influence on Operative Management of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2018;38(3):e118-21;
15. Hsiao CPT, Mark SMD, Mormino MA, Esposito PW, Burke BA. Distal Humerus Atrophic Nonunion in a Child with Osteogenesis Imperfecta. Journal of Pediatrics. 2013;33(7):725-9;
16. Guo M, Xie Y, Su Y. Open Reduction of Neglected Supracondylar Humeral Fractures with Callus Formation in Children. Journal of Pediatric Orthopaedics. 2020;40(8):e703-7;
17. Gómez VE, Gil Albarova J, Herrera A. Review and Update of the Treatment of Supracondylar Humerus Fractures in Childhood. Rev Esp Cir Osteoar. 2013;48(255):110-22;
18. Bănculescu M. quoted by: Burnei G, Burnei C, Enache FD, Daraban AM, Răducan ID. “Double X” Cross Fixation in Paediatric Supracondylar Humerus Fractures: A 20-Year Expertise and 94 Surgical Interventions. Annals of Clinical and Medical Case Reports. 2020; V5(6): 1-12;
19. Gil Albarova J, Bregante J, De Pablos J. Secondary Deformities of The Elbow in Children. En: Surgical Techniques in Orthopaedics and Traumatology, 55-260-D-50. Paris: Elsevier SAS;2004;1-6;
20. Wilkins KE, Beaty JH, Chambers HG, Toniolo RM. Fractures and Dislocations of the Elbow Region. In: Rockwood CA, Wilkins KE, Beaty JH, editors. Fractures in Children. 4th ed. Philadelphia: Lippincott-Raven; 1996. pp. 653–752;
21. Noonan KJ, Jones JW. Recurrent Supracondylar Humerus Fracture Following Prior Malunion. Iowa Orthop J. 2001;21:8–12;
22. Takahara M, Sasaki I, Kimura T, Kato H, Minami A, Ogino T. Second Fracture of the Distal Humerus after Varus Malunion of a Supracondylar Fracture in Children. Journal of Bone and Joint Surgery. 1988;80- B(5):791–797;
23. Nork SE, Hennrikus WL, Loncarich DP, Gillingham BL, Lapinsky AS. Relationship between Ligamentous Laxity and the Site of the Upper Extremity Fractures in Children: Extension Supracondylar Fracture Versus Distal Forearm Fracture. Journal of Pediatric Orthopaedics. 1999;8(2)PartB:90–2;
24. Anari JB, Arkader A, Spiegel DA, Baldwin KD. Approaching Unusual Pediatric Distal Humerus Fracture Patterns. Journal of the American Academy of Orthopaedic Surgeons. 2019;27(9):301-11;
25. Gómez VE, Gil Albarova J, Herrera A. Complications in supracondylar humerus fractures in childhood. Rev Esp Cir Osteoar. 2013;48(256):150-62;
26. Hussain S, Ahmad M, Muzaffar T. Open Reduction and Internal Fixation for Displaced Supracondylar Fractures of the Humerus in Children with Crossed K-Wires Via Lateral Approach. Chin J Traumatol. 2014;17(3):130-5;
27. Ipolito E, Moneta MR, D'Arrigo C. Post-Traumatic Cubitus Varus. Long-Term Follow-up of Corrective Supracondylar Humeral Osteotomy in Children. J Bone Joint Surg Am. 1990;72(5):757-65;
28. Kasse AN, Limam SA, Diao S, Lo FB, Sane ZC, Ady MH. Lateral Closed Wedge Ostetomy and Cross Pinning for the Treatment of Post-Traumatic Cubitus Varus Deformity. Rev int sc med (RISM) 2017;19(4)supplem:402-7;
29. Ojeaga P, Wyatt CW, Wilson P, Ho CA, Copley LAB, Ellis HB Jr. Pediatric Type II Supracondylar Humerus Fractures: Factors Associated with Successful Closed Reduction and Immobilization. Journal of Pediatric Orthopaedics. 2020;40(8):e690-6;
30. De Pablos J, Gil Albarova J, González J. Trauma to the shoulder girdle and upper limb. In: De Pablos J, González P. Child fractures. Concepts and principles. 2nd Ed. Oviedo: Prisma Cabinet of Design, 2005;
31. Mubarak CJ, Wallace CD. Complications of Supracondylar Elbow Fractures. In: Morrey BF. Traumatology of the Elbow. 3rd Ed. Madrid, Marban, 2004;
32. Ponce BA, Hedequist DJ, Zurakowski D, Atkinson CC, Waters PM. Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures. J Pediatr Orthop. 2004;24(6):610-14;
33. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative Treatment of Supracondylar Fractures of the Humerus in Children. The Consequences of Pin Placement. J Bone Joint Surg Am. 2001;83(5):735-40;
34. Ladenhauf HN, Schaffert M, Bauer J. The Displaced Supracondylar Humerus Fracture: Indications for Surgery and Surgical Options: A 2014 Update. Curr Opin Pediatr. 2014;26(1):64-9;
35. Eguia F, Gottlich C, Lobaton G, Vora M, Sponseller PD, Lee R, Jay M. Mid-term Patient-reported Outcomes After Lateral Versus Crossed Pinning of Pediatric Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(7):323-8;
36. Flynn JC, Matthews JG, Benoit RL. Blind Pinning of Displaced Supracondylar Fractures of the Humerus in Children: Sixteen Years’ Experience with Long-Term Follow-Up. J Bone Joint Surg Am. 1974;56(2):263–72;
37. Skaggs DL, Sankar WN, Albrektson J, Vaishnav S, Choi PD, Kay RM. How Safe is the Operative Treatment of Gartland Type II Supracondylar Humerus Fractures in Children? J Pediatr Orthop. 2008;28(2):139-41;
38. Kumar V, Singh A. Fracture Supracondylar Humerus: A Review. J Clin Diagn Res. 2016;10(12):1–6;
39. Kim TJ, Sponseller PD. Pediatric Supracondylar Humerus Fractures. J Hand Surg Am. 2014;39(11):2308-11;
40. Abott MD, Buchler L, Loder RT, Caltoum CB. Gartland Type III Supracondylar Humerus Fractures: Outcome and Complications as Related to Operative Timing and Pin Configuration. J Child Orth op. 2014;8(6): 473-7;
41. Kavak US, Yüce A, Koçak N, Demir H, Saltik İN, Gürakan F, Özen H. Bone Mineral Density in Children with Untreated and Treated Celiac Disease. Journal of Pediatric Gastroenterology and Nutrition: 2003;37(4):434-36;
42. Molina Mata M. Thesis: Complications of Supracondylar Humerus Fractures in Childhood. 2014-2015;3-25, Academic Course, Zaragoza University, Faculty of Medicine. Tutor: Dr. Jorge Gil Albarova. Service of Orthopedic Surgery and Traumatology, Zaragoza University Hospital;
43. Wilkins KE. Supracondylar Fractures of the Distal Humerus. En: Rockwood CA, Wilkins KE, Besty JH, Kasser RK, eds. Fractures in children. 5th ed. Philadelphia: JB Lippincott; 2007. p. 577-624;
44. American Academy of Orthopaedic Surgeons. Guideline on the Treatment of Pediatric Supracondylar Humerus Fractures 2011. http://www.aaos.org/Research/guidelines/SupracondylarFracture/SupracondylarFracture/Guideli ne.asp. Retrieved 19 December 2011;
45. Biyani A, Gupta SP, Sharma JC: Determination of Medial Epicondylar Epiphyseal Angle for Supracondylar Humeral Fractures in Children. J Pediatr Orthop 1993;13:94-7;
46. Tomori Y, Nanno M, Takai S. Clinical Results of Closed Versus Minimal-Open Reduction with Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children. Medicine (Baltimore). 2018;97(45):e13162;
47. Green DW, Widmann RF, Frank JS, Gardner MJ. Low Incidence of Ulnar Nerve Injury with Crossed Pin Placement for Pediatric Supracondylar Humerus Fractures Using a Minimal-open Technique. J Orthop Trauma. 2005;19(3):158-163;
48. Mulpuri K, Tritt BL. Low Incidence of Ulnar Nerve Injury with Crossed Pin Placement for Pediatric Supracondylar Humerus Fractures Using a Minimal-open Technique. J Orthop Trauma. 2006;20(3):234;
49. Iobst CA, Bunhor D, Skaggs DL, Frick SL. Intra-Operative Bone Stability Test. Tech Orthop. 2018;33(4):279-82;
50. Thompson RM, Hubbard EW, Elliott M, Riccio AI, Sucato DJ. Is Less More? Assessing the Utility of Early Clinical and Radiographic Follow-up for Operative Supracondylar Humerus Fractures. J Child Orthop. 2018;12(5):502-8;
51. Takagi T, Takayama S, Nakamura T, Horiuchi Y, Toyama Y, Ikegami H. Supracondylar Osteotomy of the Humerus to Correct Cubitus Varus: Do Both Internal Rotation and Extension Deformities Need to Be Corrected? J Bone Joint Surg (Am). 2010;92:1619-26;
52. Mehserle WL, Meehan PL. Treatment of the Displaced Supracondylar Fracture of the Humerus (Type III) with Closed Reduction and Percutaneous Cross-Pin Fixation. Journal of Pediatric Orthopaedics. 1991 11(6):705-11;
53. Silva M, Day MJ, Aceves-Martin B, Ebramzadeh E. Sagittal Plane Residual Deformity in Pediatric Type II Supracondylar Humerus Fractures. Journal of Pediatric Orthopaedics. 2020;40(7):e547-53;
54. Burnei G. et al. Double X Osteosynthesis in Humeral Supracondylar Fractures with Malunion and Joint Stiffness Risks. 32nd EPOS Annual Meeting; 17-20 of April 2013; Athens, Greece.