The Utility of Kapandji Technique in Closed Reduction and Percutaneous Pinning Of Completely Displaced Pediatric Supracondylar Fracture of Humerus: Technical Note

Document Type : TECHNICAL NOTE

Authors

BRJ Orthocentre & MAK Hospital, Coimbatore, India

10.22038/abjs.2024.80084.3664

Abstract

The standard treatment for displaced pediatric supracondylar fracture of humer us (PSCFH) is 
closed reduction and percutaneous pinning under image intensifier guidance. This technical note 
describes Kapandji intrafocal pinning technique (KIPT) for achieving optimal fracture reduction 
and stable fixation in Gartland Type III or IV extension type PSCFH. In KIPT, a K wire was 
introduced into the fracture site from the posterior aspect, fracture manipulatio n was done by 
levering with wire reducing the posterior displacement of the distal fragment and the wire was 
fixed to the anterior cortex of the proximal fragment. After this sagittal plane reduction and 
stabilization with intrafocal wire , coronal plane reduction could be carried out easily. This was 
followed by pinning of columns: all lateral or crossed (medial and lateral). In completely displaced 
extension type PSCFH, KIPT achieves ideal fracture reduc tion without vigorous manipulation in 
short surgical time and enables easy column pinning.
 Level of evidence: II

Keywords

Main Subjects


  1. Bahaeddini MR, Senemari MH, Salehi Beromi M, et al.Epidemiological Characteristics of Pediatric Supracondylar of Humerus Fractures in a Tertiary Hospital in Iran. . Arch Bone Jt Surg. 2024; 12(5):333-336. doi: 10.22038/ABJS.2024.73619.3409.
  2. Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop.2012:32 Suppl 2:S143-52. doi: 10.1097/BPO.0b013e318255b17b.
  3. Kapandji A. [Intra-focal pinning of fractures of the distal end of the radius 10 years later]. Ann Chir Main.1987; 6(1):57-63. doi: 10.1016/s0753-9053(87)80011-x.
  4. Satish BR, Vinodkumar M, Suresh M, Seetharam PY, Jaikumar K. Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures. Orthopedics. 2014; 37(9):e810-6. doi: 10.3928/01477447-20140825-58.
  5. Fahmy MA, Hatata MZ, Al-Seesi H. Posterior intrafocal pinning for extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Br. 2009; 91(9):1232-6. doi: 10.1302/0301-620X.91B9.22425.
  6. Kao HK, Yang WE, Li WC, Chang CH. Treatment of Gartland type III pediatric supracondylar humerus fractures with the Kapandji technique in the prone position. J Orthop Trauma. 2014; 28(6):354-9. doi: 10.1097/BOT.0000000000000015.
  7. Pei X, Mo Y, Huang P. Leverage application on Gartland Type IV supracondylar humeral fracture in children. Int Orthop. 2016; 40(11):2417-2422. doi: 10.1007/s00264-016-3206-3.
  8. Choi PD, Skaggs DL. Closed reduction and percutaneous pinning of supracondylar fractures of the humerus. In: Operative techniques in orthopedic surgery. 1th ed. Wiesel S,eds. Philadelphia: Lippincott William & Wilkins; 2011.
  9. Juan Pretell Mazzini, Jaun Rodriguez Martin,Eva María Andres Esteban. Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: a systematic review J Child Orthop. 2010;(2):143-52
  10. Balakumar B, Madhuri V. A retrospective analysis of loss of reduction in operated supracondylar humerus fractures. Indian J Orthop. 2012; 46(6):690-7. doi: 10.4103/0019-5413.104219.
  11. Tellisi N, Abusetta G, Day M, Hamid A, Wahab KA, Ashammakhi N. Management of Gartland's type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury.2004; 35(11):1167-71. doi: 10.1016/j.injury.2004.01.006.
  12. Soldado F, Knorr J, Haddad S, et al. Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to avoid Ulnar Nerve Injury. Arch Bone Jt Surg. 2015; 3(3):169-72.