To the Editor,
We read the article ‘Lateral External Fixation For Displaced
Unreducible Humeral Fractures in Children’ with great interest. We agree that the treatment of irreducible supracondylar fractures is
challenging and often requires open reduction. In our experience, excessive
swelling around the elbow and soft tissue interposition are perhaps the
most common causes of failure of closed reduction. It is, therefore,
difficult to understand how the administration of Schanz pins could reduce
the completely displaced and rotated distal fragment without
opening the fracture site. Alternatively, forced closed reduction of such a
fracture and its subsequent maintenance with an external fixator might cause
entrapment of the neurovascular structures at the fracture site leading
to disastrous complications. Thus, we prefer open reduction as it allows careful clearance of all soft tissues from the
fracture site and permits anatomic reduction of the fracture before
fixation with K-wires.
Due to the peculiar flattened and rounded shape of the distal
humerus, the placement of Shanz pins may be quite challenging, especially
if the distal fragment is small and the elbow is grossly swollen. The
risks of pin slippage and neurovascular damage are high.
The authors also used a Kirschner wire to achieve additional
stability which casts doubt on the real need for the addition of an ‘external
device’ which is unsightly and difficult to handle, especially in
children. Another cross wire would probably achieve the same or better
result instead of an external fixator. Accurately reduced fractures
stabilized with K-wires rarely fail with the open method. Good range of
movement is generally achieved with excercises.
The risk of neurovascular complications, lack of compliance, pin site
care and social embarrassment are issues that need to be considered, when
treatment with external fixator is being offered, particularly to a child.
In our opinion, a majority of surgeons and patients/parents would
still feel more comfortable and confident with open reduction and fixation
with wires for an irreducible supracondylar fracture of the humerus rather
than resorting to ‘closed’ external fixation.
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Letters to the Editor: ![[Read Letter to the Editor]](/icons/misc/sectionDOWN.gif){kind=icon}
