RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

SYNOPSIS

OF

DISSERTATIONDR . ANVESH GATTUDEPARTMENT OF ORTHOPAEDICSVYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTER,WHITEFIELD, BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1Name of the candidate and address (in block letters) DR.ANVESH GATTUDEPARTMENT OF ORTHOPAEDICS, VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE, WHITEFIELD, BANGALORE.

2Name of the InstitutionVYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE

BANGALORE - 66

3Course of the study and subjectM.S. ORTHOPAEDICS

4Date of admission to course18-04-2011

5Title of the topic

SURGICAL MANAGEMENT OF DISPLACED SUPRA CONDYLAR HUMERUS FRACTURES IN CHILDREN WITH PERCUTANEOUS PINNING.

6Brief resume of the intended work

6.1 Need for the study Of all the fractures in the upper limb the supracondylar fracture of the humerus is not only the most common injury but can result in serious complications if not treated appropriately.

In general fractures in children are treated conservatively.Surgical treatment is reserved for some physeal injuries,fractures associated with neurovascular compromise,open fractures and certain special circumstances like fractures around hip.The management of supra condylar fractures of humerus has evolved from a purely conservative approach to a more aggressive approach in recent years.Supra condylar fractures need a precise treatment inorder to obtain a satisfactory result because of low bone remodeling associated with these injuries.It is important to use a systematic procedure for acceptable outcome.1 Extension type fractures, which accounts for approximately 97- 99% of supra condylar humeral fractures are usually due to fall on the out stretched hand with elbow in full in extension and management of undisplaced fractures is usually conservative,but the management of the completely displaced fracture is more controversial.1 The aim of the present study is to evaluate the results of percutaneous pinning of unstable or irreducible type II and III supracondylar humeral fractures in children.

6.2 Review of literature: In a study conducted by NY OTSUKA, they concluded that the treatment of type II and type III supracondylar fractures of the humerus in children with closed reduction and percutaneous pinning has dramatically lowered the rate of complications from the injury.The incidence rates of malunion (cubitus Varus) and compartment syndrome have both decreased.2 In a study conducted by Rijal KA, in their study concluded that percutaneous crossed K wire pinning after closed manipulation in supracondylar extension type III fractureof the humerus is a reliable and safe method of treatment and is recommended in all.3 In a study conducted by Devkota P et al, found that closed reduction and percutaneous K wire pinning in the management of supracondylar fractures of humerus in children is safe as regards avoidance of vascular complications, effective in obtaining good results and relatively economical regarding hospitalization.The disadvantage is the need for proficiency and the availability of C arm fluoroscopy.4 In a study conducted by Haque MR, found that open reduction and internal fixation by K wire is an excellent method of management of supracondylar fractures of humerus in children when the reduction could not be achieved by closed means.5

In a study conducted by Jessica C.Babal, they found that medial pinning carries the greater overall risk of nerve injury as compared with lateral only pinning and that the ulnar nerve is at risk of injury in medially pinned patients.6 In a study conducted by Noor Akbar Sial, in their study concluded that open reduction and crossed pin fixation is a sound and effective modality for the treatment of displaced supracondylar fractures with the advantages of decreased duration of hospital stay, anatomical reduction, stable fixation and early mobilization.7 In a study conducted by Aman dua, they concluded that closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed union.8

6.3 Objectives of the study

1. Accuracy of reduction and its radiological evaluation by Baumanns angle.2. Maintenance of reduction later on because of internal fixation.3. To find out final range of movements of the elbow joint in terms of flexion and extension. 4. Comparison of carrying angle of both elbows in final follow up.

7 Materials and Methods

7.1 Source of data

The study will be conducted on children undergoing surgical management of unstable or irreducible type II and III supracondylar humeral fractures in Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Bangalore.

7.2 Method of collection of data (including sampling procedure if any)Study Design : Observational prospective studyDuration of study :1 yr,during study period of Jan 2012 to Dec 2012.

Sample size 30.Inclusion criteria:

1. Both sexes.

2. Age less than 12 yrs3. children with unstable displaced or irreducible type II fractures. 4. type III supracondylar humeral fractures.

Exclusion criteria:

1. Undisplaced fractures.2. Compound fractures.3. Comminuted fractures.

4. Those who had previous attempt of manipulationsMethodology: Patients will be selected based on inclusion and exclusion criteria and under general anaesthesia with aseptic precautions, closed manipulative reduction and percutaneous pinning with K wires of 1.6 to 2 mm will be done under C arm fluoroscopy.First wire will be introduced from lateral side and second from the medial side.The K wires will be bent and cut outside the skin so that pin removal could be facilitated after 3 weeks post operatively. Follow up protocol: Patients will be followed up regularly at 2 wks,6 wks and 12 wks post operatively and each time will be assessed radiologically for reduction and union, and clinically for range of motion and carrying angle. Radiographs will be taken and range of motion exercises will be started by encouraging patients to perform active flexion and extension exercises

Statistical analysis: Statistical methods : Chi-square test.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animal? If so, please describe briefly.

Standard routine investigations required for pre anaesthetic check up. Intervention to be conducted on patient is percutaneous pinning and surgery.

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes, copy enclosed.

References

1. Lee EH. Supra condylar fractures of the humerus in children Back to Basics. Singapore Med J 2000, 41 (9): 423 424.

2. Otsuka NY, Kasser JR.Supra condtlar fractures of the humerus in children. J Am Acad Orthop Surg 1997Jan, 5(1): 19 26.3. Rijal KP, Pandey BK. Supracondylar extension type III fracture of the humerus in children: Percutaneous cross pinning. Kathmandu University Medical Journal 2006,4(4):465 469.

4. Devkota P, Khan JA, Acharya BM, Pradhan NMS, Mainali LP, Singh M et al. Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning. J Nepal Med Assoc 2008; 47(170):66 70.5. Haque MR, Haque AM, Hamid F, Hossain MD. Displaced Supracondylar Fractures of the Humerus in Children:Treatment by Open Reduction and Internal Fixation by Two Crossed Kirschner Wires. Dinajpur Med Col J 2010 Jan; 3 (1):25 28.6. Babal JC, Mehlman CT, Klein G .Nerve injuries Associated with Pediatric Supracondylar Humeral Fractures: A Meta analysis. J Pediatr Orthop 2010;30:253 263.

7. Sial NA, Yasin A, Rashid A. Supracondylar Humerus Fractures outcome of open reduction and percutaneous crossed pin fixation. Professional Med J Mar 2011;18(1): 147 153.8. Dua A, Eachempati KK, Malhotra R, Sharma L, Gidaganti M. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation. Chin J Traumatol 2011; 14(1): 14 19.

l9Signature of the candidate

10Remarks of the guide

Supracondylar fracture in children poses a difficult situation regarding management .This study will help in proper evaluation of fracture and stable fixation in displaced fracture , this will help in avoiding malunion and deformities and early functional recovery.

11Name and designation of the guide (in block letters)

11.1 Guide Dr .Vishwanath.M.S Professor Department of Orthopaedics, VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE,WHITEFIELD,

BANGALORE.

11.2 Signature

11.3 Head of the Department Dr .MURALIDHAR.N Professor and Head of the Department,

Department of Orthopaedics, VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE,WHITEFIELD,

BANGALORE.

11.4 Signature

1212.1 Remarks of the Chairman & Principal

12.2 Signature