SYNOPSIS

FUNCTIONAL OUTCOME OF TYPE III SUPRACONDYLAR

FRACTURE HUMERUS IN CHILDREN TREATED BY

PERCUTANEOUS PINNING TECHNIQUE / OPEN

REDUCTION INTERNAL FIXATION

Dr.JOSE POULOSE P POSTGRADUATE RESIDENT

MS ORTHOPAEDICS AJIMS

CURRICULUM VITAE

Name : Dr.Umananda Mallya P

Date of Birth & Age : JUNE 26, 1952 – 61 Years

Present Designation : PROFESSOR

Department : ORTHOPAEDICS

College : A.J. Institute of Medical Sciences

City : MANGALORE

Residential Address of employee : 3-31-2621/30 KADRI ROAD MANGALORE

Contact Particulars: Tel(Office) : 0824-2225533

Mobile Number : 9845082930

Date of joining present institution : JUNE 27,2012 as PROFESSOR

2. Qualifications:

Qualification College University Year

Registration No. of UG & PG with date

Name of the State Medical

CouncilMBBS Kasturba

medical college,mangalore

Mysore university August 1975

1329704-12-1975

Karnataka medical council

MS(ortho)

Kasturba medical college,mangalore

Mysore university January

1982

1329706-06-1983 Karnataka

medical council

D'ortho Kasturba medical college,mangalore

Mysore university

1978 Karnataka medical council

3. Details of the previous appointments/teaching experience

Designation Department Name of Institution FromMM/DD/

YY

ToMM/DD/

YY

Total Experien

ce in years & months

Junior resident orthopaedics Kasturba medical college,mangalore

Aug 29,1979

Feb 08,1982

3 years

lecturer orthopaedics Kasturba medical college,mangalore

Sep 01,1982

Aug 31,1984

2 years

Assistant Professor

orhtopaedics Kasturba medical college,mangalore

Sep 01,1984 31/07/88 3 years 11

months

Reader orthopaedics Kasturba medical college,mangalore

Aug 01,1988

July 31,1990

2 years

Associate Professor

orthopaedics Kasturba medical college,mangalore

Aug 01,1990

July 31,1992 2 years

Professor orthopaedics Kasturba medical college,mangalore

Aug 01 ,1992

June 18, 2009

13 years,10months,1

8 daysProfessor and head

orthopaedics Kasturba medical college,mangalore

June 19,2006

June 18,2009

3 years

CURRICULUM VITAE

Name : Dr.Jose Poulose P

Date of Birth : DECEMBER 23 1987-26 Years

Present Designation : Junior Resident

Department : ORTHOPAEDICS

College : A.J.Institute of Medical Science

City : MANGALORE

Residential Address : flat no:305,inland salute,akashbhavana

main road,konchadi,4th mile,kavur,mangalore

Ph & Fax No with code : Office : 0824– 2217794Mob No : 9902662983

Email Address : josepoulosep@gmail.com

Date of joining present Institution : JUNE 5, 2013 as Junior Resident

Qualification:

Qualification College University Year Registration No of UG & PG with date

Name of the State Medical Council

MBBS AMALA INSTITUTE OF MEDICAL SCIENCES,THRISSUR.KERALA

CALICUT UNIVERSITY,KERALA

01/03/11 45314,23-5-2012 The Travancore cochin medical council

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE

ANNEXURE II

THESIS SYNOPSIS

1. Name of

candidate and

Address

Dr Jose Poulose PPost Graduate in

Department of Orthopaedics

A.J. Institute of Medical Sciences , Mangalore

2. Name of the

Institution

A.J. Institute of Medical Sciences ,Mangalore

3. Course of

Study and

Subject

MS in Orthopaedics

4. Date of

Admission

July, 6,2013

5. Title of Topic FUNCTIONAL OUTCOME OF TYPE III SUPRACONDYLAR FRACTURE HUMERUS IN CHILDREN TREATED BY PERCUTANEOUS PINNING TECHNIQUE / OPEN REDUCTION INTERNAL FIXATION

6. Brief Resume

of the intended

Work

6.1 Need For

the Study

Supracondylar humerus fractures are the most common elbow fractures during childhood (abut 60 %), if not treated appropriately can result in serious complications.

The management of supra condylar fractures of humerus has evolved from a purely conservative approach to a more of a surgical approach in recent years.Supra condylar fractures need a precise treatment in order to obtain a satisfactory result because of low bone remodeling associated with these injuries.

Extension type fractures, which accounts for approximately 97- 99% of supra condylar humeral fractures are usually due to fall on the

AIM OF

STUDY

out stretched hand with elbow in full in extension .

Management of undisplaced fractures is usually conservative,but the management of the completely displaced fracture depends on reduction obtained by percutaneous pinning or open reduction internal fixation.

The aim of the present study is to 1. Asses the efficiency of ORIF as an effective treatment for type III supracondylar fracture humerus in children.2. To study the role of percutaneous pinning as an alternative to primary open reduction in type III supracondylar fracture humerus in children.3. To compare the functional results of percutaneous pinning and open reduction internal fixation.

6.2. Review of

literature

6.1 Review of literature:

In a study by ROBERT D. D'AMBROSIA normal elbow motion resulted following each method of closed treatment but open reduction caused some loss in extension.Overhead threaded pin traction was safe and the swelling of the elbow rapidly decreased as gravity hastened venous and lymphatic drainage.Overhead pin traction prevented residual varus deformity possibly because it provided a position of mild pronation of the forearm. Closed reduction followed by a collar and Cuff also prevented residual varus deformity, possibly because of the neutral or pronated position of the forearm.In their opinion supinated position of the forearm should be avoided in the treatment of supracondylar fractures of the elbow in children1.

In a study conducted by JOSEPH C. FLYNN; JOSEPH G. MATTHEWS; ROGER L. BENOIT ,difficulty in mastering the technique was the only major disadvantage, and was overcome by using a simple holding bracket during the pinning. varus deformity was prevented by avoiding medial tilt of the distal fragment. our long-term study showed that the fixation pins do not disturb the growth potential of the distal end of the humerus. cubitus varus, when it

occurred, was a result of imperfect reduction rather than growth disturbance. in fifty-two fractures on long-term follow-up, satisfactory results were recorded in 98 per cent. vascular and neural complications were minor, and no volkmann's contractures were seen2.

In a study by EE PALMER; KM NIEMANN; D VESELY; JH ARMSTRONG,Seventy-eight supracondylar fractures of the humerus in children were reviewed to compare four kinds of treatment: closed reduction and immobilization in a cast or splint, overhead skeletal traction, side-arm skeletal traction, and Dunlop's skin traction. The skeletal traction device usually used was a winged screw of our own design. The arms treated in overhead traction had significantly less change in carrying angle than those treated in side-arm traction. Significant changes in carrying angle were encountered in three instances of medially impacted so-called non-displaced fractures. Overhead traction, utilizing a winged traction screw, was the most effective method of treatment that we found. There were no instances of Volkmann's ischemic contracture3.

In a study by K. MAZDA, C. BOGGIONE, F. FITOUSSI, G. F. PENNECOT ,a prospective study reported the results of 116 consecutive displaced extension supracondylar fractures of the elbow in children treated during the first two years after the introduction of the following protocol; closed reduction under general anesthesia with fluoroscopic control and lateral percutaneous pinning using two parallel pins or, when closed reduction failed, open reduction and internal fixation by cross-pinning5. The protocol described resulted in good or excellent results in 96% of our patients, providing a safe and efficient treatment for displaced supracondylar fractures of the humerus even in less experienced hands4.

Study done by J. MANGWANI, R. NADARAJAH, J. M. H. PATERSON although supracondylar fracture is a very common elbow injury in childhood, there is no consensus on the timing of surgery, approach for open reduction and positioning of

fixation wires5.

In a study conducted by M. SIBINSKI, H. SHARMA, G. C. BENNET,examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later.The study confirmed that the treatment of uncomplicated displaced supracondylar fractures of the humerus can be early or delayed. In these circumstances operations at night can be avoided6.

In a study conducted by P. J. WALMSLEY, M. B. KELLY, J. E. ROBB, I. H. ANNAN, D. E. PORTE, In this retrospective study they examined whether the timing of surgery affected peri-operative complications, or the need for open reduction. There were no differences in the rate of complications between the groups, but children waiting more than eight hours for reduction were more likely to undergo an open reduction and there was a weak correlation between delay in surgery and length of operating time7.

In a study by H.-Y. LEE, S.-J. KIM ,This study was aimed to evaluate the use of pin leverage in the reduction of Gartland type III supracondylar fractures of the humerus in children, lead us to pin leverage method of reduction gives good results in the treatment of Gartland type III fractures8.

In a study by FRANCES A. FARLEY,PRERANA PATEL, CLIFFORD L. CRAIG,LAUREL C. BLAKEMORE,ROBERT N. HENSINGER,LINGLING ZHANG,AND MICHELLE S. CAIRD ,Pediatric supracondylar humerus fractures: treatment by type of orthopedic surgeon ,For the severe fractures, significantly more fractures were treated by open reduction in the paediatric orthopedic surgeon group than in the non paediatric orthopedic surgeon group. There were no other significant differences in outcomes between the fractures treated by the pediatric orthopedic surgeons and nonpaediatric orthopedic surgeons. This study supports the assertion that both peadiatric and nonpaediatric orthopedic surgeons in an academic setting have sufficient training, skill, and experience to treat these common injuries9.

In a study by CEMAL KAZIMOGLU, MURAT CETIN, MUHITTIN SENER,HALUK AGUS AND ONDER KALANDERER ,Operative management of type III extension supracondylar fractures in children ,concluded that open reduction and internal fixation is an effective secondary treatment protocol for type III supracondylar fractures with results comparable to closed reduction and pinning. If the closed reduction fails initially, open reduction or skeletal traction and delayed percutaneous fixation can be preferred according to the surgeon’s experience10 .

In a study by LEWIS E. ZIONTS, MD,CHRISTOPHER J. WOODSON, MD, NAHID MANJRA PA AND CHARALAMPOS ZALAVRAS MD,Time of Return of Elbow Motion after Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures,observed loss of motion of 45° by 6 weeks and 22° by 12 weeks postoperatively, but there was substantial improvement with subsequent followup. After closed reduction and percutaneous pinning of a displaced, uncomplicated, extension-type supracondylar humerus fracture, 94% of the child’s normal elbow ROM should be expected by 6 months after pinning. Additional improvement may be anticipated to occur as much as 1 year after the injury11.

In a study by IRENA KRUSCHE-MANDL, SILKE ALDRIAN, JULIA KOTTSTORFER, ASTRID SEIS, GERHILD THALHAMMER, AND ALEXANDER EGKHER,showed crossed pinning in paediatric supracondylar humerus fractures is a safe and effective method with a low incidence of complications. It is crucial to achieve adequate reduction and K-wire stabilization, especially to avoid malrotation and tilting of the distal fragment in the coronal plane to obtain correct alignment. In cases where the ulnar nerve is palpable in the ulnar groove, blind percutaneous crossed pin placement is safe. If closed reduction fails or ulnar nerve subluxation cannot be excluded, a medial mini-open approach to visualize the nerve is certainly safer and should be preferred12.

In a study by ABHIJAN MAITY, DEBASISH SAHA, AND DEBASIS SINHA ROY,A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children ,There were no significant differences between the two groups with regard to base-line characteristics, withdrawals and complication rate.If a uniform standardized operative technique is followed in each method, then the result of both the percutaneous fixation methods will be same in terms of safety and efficacy13.

In a study by SANGLIM LEE, MD, MOON SEOK PARK, MD,Consensus and Different Perspectives on Treatment of Supracondylar Fractures of the Humerus in Children ,Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. .Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient's age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor14.

6.3 Objective

of the study 1. To study functional outcome after percutaneous

pinning or open reduction internal fixation of type III supracondylar fracture humerus in children.

2. To study accuracy of reduction and radiological evaluation by Baumann's angle.

3. Comparison of carrying-angle of both elbows in final follow up.

7 Material and

Methods

7.1 Source of

Data

The study will be conducted on children undergoing

surgical management of unstable or irreducible type III

supracondylar humeral fractures in Department of

Orthopaedics, A J Institute of Medical Sciences,

mangalore .

7.2 Method of

Collection of

data and

sample

7.2 Method of collection of data (including sampling procedure if any)

Study Design :prospective study

Duration of study :1 ½ yrs ,during study period of OCTOBER 2013 to FEBRUARY 2015.

Sample size – 30.

Inclusion criteria:

1. Both sexes.2. Age group 3 – 12 years.3. type III supracondylar humeral fractures.4. isolated type III supracondylar fracture

humerus.

Exclusion criteria:

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

4. Other bone fracture in upper limb.Methodology:

patient brought to department of emergency medicine

with history of injury to elbow.

Patient will be initially immobilized using a arm sling.

Analgesics will be given.

X-rays will be taken both anteroposterior and lateral

views.

Fracture will be classified according to Gartland

classification.

Patients will be selected based on inclusion and

exclusion criteria for the study.

Surgery will be planned accordingly ,all the pre

operative investigations will be done,fitness taken and

patient taken to operation theatre.

POSITIONING:

Patient will be placed supine on the operating table and

the limb involved will be isolated and draped.

PERCUTANEOUS PINNING:

Under suitable anesthesia 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.Two smooth k-wire will be inserted

through the lateral epicondyle and parallel to each other

reduction is confirmed by a c-arm fluroscopy or a

smooth k-wire will be introduced from lateral epicondyle

through the fracture site to engage the opposite cortex

and second from the medial side 3cm proximal to medial

epicondyle on the supracondylar ridge through the

fracture to opposite cortex.The K – wires will be bent

and cut outside the skin so that pin removal could be

facilitated after 3 weeks post operatively.

OPEN REDUCTION INTERNAL FIXATION:

Open reduction internal fixation done under suitable

anesthesia, closed reduction will be attempted first; in

the event of its failure, a pneumatic tourniquet was

applied and posterior midline incision about 6-7cm will

be made. Ulnar nerve will be identified, dissected and

isolated. After elevating triceps muscle, the fracture side

will be cleared, reduced and fixed with 2 cross K-wires

of appropriate diameter under c-arm fluroscopy through

the medial and lateral epicondyles.The ends of the wires

will be left outside the skin for easy removal later on.

Skin will be closed and posterior slab will be applied.

Postoperative check x-ray both antero posterior as well

as lateral views will be taken to confirm the

reduction.The neurovascular will be monitored

postoperatively.

Follow up protocol:

Patients will be followed up regularly at 2 wks,6 wks

and 12 wks post operatively and each visit he/she will

be assessed radiologically for reduction and union, and

clinically for range of motion and carrying angle

according to Flynn's criteria.Based on the above results

range of motion exercises will be started by encouraging

patients to perform active flexion and extension

exercises.

Flynn's criteria:

Cosmetic factor carrying-angle loss(degrees)

Functional factor movement

loss(degrees)

Excellent 0 to 5º 0 to 5º

Good 5 to 10º 5 to 10º

Fair 10 to 15º 10 to 15º

Poor >15º >15ºStatistical analysis: Statistical methods : Chi-square test.

7.3 Does the

study requires

any

investigations

or

interventions

to be

conducted on

patient or

other human

or animals? If

so, please

describe

briefly.

Standard routine investigations required for pre

anesthetic check up. Intervention to be conducted on

patient is

1. percutaneous pinning

2. open reduction and internal fixation.

7.4 has the

ethical

clearance

obtained

yes

8. List of

References

References

1. Robert d. D'ambrosia supracondylar fractures of

humerus—prevention of Cubitus Varus,j Bone Joint

Surg Am, 1972 Jan 01;54(1):60-66.

2. Joseph C. Flynn; Joseph G. Matthews; Roger L.

Benoit 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 mar 01;56(2):263-272.

3. Ee Palmer; Km Niemann; D Vesely; Jh

Armstrong ,Supracondylar fracture of the humerus in

children ,J Bone Joint Surg Am, 1978 Jul 01;60(5):653-

656.

4. K. Mazda, C. Boggione, F. Fitoussi, G. F. Pennecot

Systematic pinning of displaced extension-type

supracondylar fractures of the humerus in children J

Bone Joint Surg [Br] 2001;83-B:888-93.

5. J. Mangwani, R. Nadarajah, J. M. H. Paterson

Supracondylar humeral fractures in children J Bone

Joint Surg [Br] 2006;88-B:362-5.

6. M. Sibinski, H. Sharma, G. C. Bennet Early versus

delayed treatment of extension type-3 supracondylar

fractures of the humerus in childrenJ Bone Joint Surg

[Br] 2006;88-B:380-1.

7. P. J. Walmsley, M. B. Kelly, J. E. Robb, I. H. Annan,

D. E. Porter Delay increases the need for open

reduction of type-III supracondylar fractures of the

humerus J Bone Joint Surg [Br] 2006;88-B:528-30.

8. H.-Y. Lee, S.-J. Kim Treatment of displaced

supracondylar fractures of the humerus in children by a

pin leverage technique Bone Joint Surg [Br] 2007;89-

B:646-50 .

9. Frances A. Farley, Prerana Patel, Clifford L. Craig,

Laurel C. Blakemore, Robert N. Hensinger, Lingling

Zhang And Michelle S. Caird,Pediatric supracondylar

humerus fractures: treatment by type of orthopedic

surgeon ,J Child Orthop. 2008 March; 2(2): 91–95.

10. Cemal Kazimoglu, Murat Cetin, Muhittin

Sener,Haluk Agus,And Onder Kalanderer ,Operative

management of type III extension supracondylar

fractures in children ,Int Orthop. 2009 August; 33(4):

1089–1094.

11. Lewis E. Zionts, MD, Christopher J. Woodson, MD,

Nahid Manjra, PA and Charalampos Zalavras, MD

Time of Return of Elbow Motion after Percutaneous

Pinning of Pediatric Supracondylar Humerus

Fractures ,Clin Orthop Relat Res. 2009 August; 467(8):

2007–2010.

12. Irena Krusche-Mandl, Silke Aldrian, Julia

Kottstorfer, Astrid Seis, Gerhild Thalhammer, And

Alexander Egkher ,Crossed pinning in paediatric

supracondylar humerus fractures: a retrospective cohort

analysis ,Int Orthop. 2012 September; 36(9): 1893–

1898.

13. Abhijan Maity, Debasish Saha,2and Debasis Sinha

Roy ,A prospective randomised, controlled clinical trial

comparing medial and lateral entry pinning with lateral

entry pinning for percutaneous fixation of displaced

extension type supracondylar fractures of the humerus

in children ,J Orthop Surg Res. 2012; 7: 6.

14. Sanglim Lee, MD, Moon Seok Park, MD, Chin Youb

Chung, MD, Dae Gyu Kwon, MD, Ki Hyuk Sung,

MD,Tae Won Kim, MD, In Ho Choi, MD,Tae-Joon

Cho, MD,Won Joon Yoo, MD, and Kyoung Min Lee,

MD ,Consensus and Different Perspectives on

Treatment of Supracondylar Fractures of the Humerus

in Children ,Clin Orthop Surg. 2012 March; 4(1): 91–

97.

9. Signature of

Candidate:

10. 10.1 Name and

designation of

Guide

Dr.Umananda Malaya PProfessor

10.2 Signature

10.3 Co –

Guide (if any)

Dr. Mahesh Shetty

10.4

Signature

10.5 Dr. Sudarshan Bhandary

Head of the

department :

10.6 Signature

12 12.1 Remarks

of the

Chairman and

Principal

Signature

CONSENT FOR PARTICIPATION IN RESEARCH

TITLE OF RESEARCH

FUNCTIONAL OUTCOME OF TYPE III SUPRACONDYLAR FRACTURE HUMERUS IN CHILDREN TREATED BY PERCUTANEOUS PINNING TECHNIQUE / OPEN REDUCTION INTERNAL FIXATION.INVESTIGATORS:

Dr Umananda Mallya P,PROFESSOR,Department of orthopaedics,A J institute of medical sciences.

Dr Jose poulose p ,Post graduation resident,Department of orthopaedics,A J institute of medical sciences.

INTRODUCTION

I Dr Jose Poulose P, will be doing my dissertation on the study of FUNCTIONAL OUTCOME OF TYPE III SUPRACONDYLAR FRACTURE HUMERUS IN CHILDREN TREATED BY PERCUTANEOUS PINNING TECHNIQUE / OPEN REDUCTION INTERNAL FIXATION .

PRIVACY AND CONFIDENTIALITYThe results of the study may be published for scientific purposes and / or to scientific groups. However you will not be identified. Privacy and confidentiality of the study participants will be ensured.

INSTITUTIONAL POLICYThe A.J. Institute of medical sciences will provide, within the limitations of the laws of the State of Karnataka, facilities and medical attention to subject who suffer injuries as a result of participating in its projects. In the event if you believe that you have suffered any physical injuries as a result of your participation in this study, you may contact principal investigator Dr.Jose Poulose P or Dr. Umananda Mallya p ( Guide).

CONTACTSIf you have any questions about the research you may please contact Dr. Ramesh Pai , Principal and Chairman of Ethical Committee, A.J. Institute of medical sciences, Mangalore-04. In case of any emergency you may contact, Dr.Jose Poulose P, Post Graduate Student, Dept of Orthopaedics, A.J.Institute of medical sciences, Kuntikana, Mangalore-04, Telephone no: 9902662983 or Dr. Umananda Mallya P, PROFESSOR, Dept of Orthopaedics,A.J.Institute of medical sciences, Mangalore-04,Telephone no:9845082930.Your decision whether or not to participate in the study will not affect the standard care during your current or future relations with the hospital. You are free to discontinue the study at any time and for any reason.

STATEMENT OF CONSENT I volunteer and consent to participate in the study. I have read the consent or it has been read to me. The study has been fully explained to me and I may ask questions at anytime.

1)Signature/Thumb impression of Patient

2)Signature of Patients Guardian

3)Name & Signature of Investigator

From

Dr.Jose Poulose P ,

Post Graduate in Department of ORTHOPAEDICS

A.J. Institute of Medical Sciences

Mangalore

To

The Registrar (Evaluation)

Rajiv Gandhi University of Health Sciences

Bangalore, Karnataka

(Through Proper Channel)

Sub:- Submission of Synopsis of Dissertation

Respected Sir,

Herewith, I am submitting synopsis of my dissertation work FUNCTIONAL OUTCOME

OF TYPE III SUPRACONDYLAR FRACTURE HUMERUS IN CHILDREN TREATED BY

PERCUTANEOUS PINNING TECHNIQUE / OPEN REDUCTION INTERNAL FIXATION

–for registration in M.S. (orthopaedics) of A.J. Institute of Medical Sciences Mangalore.

Kindly accept the same and oblige.

Thanking you.

Yours faithfully,

Place : Mangalore

Date : 09.10.2013

(Jose Poulose P)

Dr. Sudarshan Bhandary

Prof. and head, department of orthopaedics,

A.J. Institute of Medial Sciences

MANGALORE

PROFORMA

FUNCTIONAL OUTCOME OF TYPE III SUPRACONDYLAR FRACTURE

HUMERUS IN CHILDREN TREATED BY PERCUTANEOUS PINNING

TECHNIQUE / OPEN REDUCTION INTERNAL FIXATION

1. NAME: AGE: SEX:

2.ADDRESS:

3.IP NO:

4.SIDE INVOLVED:

5.HANDEDNESS:

6.HISTORY (MODE OF INJURY):

FALL ON OUTSTRECHED HANDS

DIRECT BLOW

OTHERS:

SPORTS RELATED INJURIES

ROAD TRAFFIC ACCIDENTS... ETC

5.DATE AND TIME OF INJURY:

6.DATE AND TIME PATIENT SEEN IN OUR HOSPITAL:

7.ANY FIRST AID GIVEN : YES /NO

8.LOCAL EXAMINATION:

1.LIMB INVOLVED

2.TYPE OF FRACTURE ---SIMPLE/COMPOUND

---FLEXION/EXTENSION

3.NERVE INJURY- 1.MEDIAN NERVE

2.RADIAL NERVE

3.ULNAR NERVE

4.VASCULAR STATUS : 1.RADIAL PULSE

2.PERIPHERAL CIRCULATION

3.VOLUNTARY FINGER EXTENSION

5.ASSOCIATED OTHER BONY INJURIES

6.SOFT TISSUE PATHOLOGY:1.LOCAL TENDERNESS

2.SWELLING

3.SKIN PUCKERING

15.INVESTIGATIONS:

X RAY FINDINGS:

1.TYPE OF FRACTURE ACCORDING TO GARTLAND CLASSIFICATION

2.FAT PAD SIGN

3.EXTENSION INTO THE SHAFT PRESENT OR NOT

4.ASSOCIATED BONY INJURIES

17.SURGERY:

1.TYPE OF FRACTURE

2.TIME OF SURGERY –IMMEDIATE/DELAYED

3.DATE OF SURGERY

4.TYPE OF SURGERY:a.OPEN REDUCTION INTERNAL FIXATION

b.PERCUTANEOUS PINNING

5.ANAESTHESIS –

6.APPROACH

7.IMPLANT USED

POST OPERATIVE ASSESSMENT:

1.VASCULAR STATUS

2.COMPLICATIONS

3.CHECK X-RAY

4.BAUMANN'S ANGLE

5.ANTERIOR HUMERAL LINE

6.DISPLACEMENT:

a.ANTERIOR

b.MEDIAL

c.POSTERIOR

TIME OF SUTURE REMOVAL

DURATION OF HOSPITAL STAY

RESULT :

a.CUBITUS VARUS/CUBITUS VALGUS

b.RANGE OF MOVEMENTS:ELBOW FLEXION / EXTENSION

FOLLOW UP AT 6WKS/12 WKS/6 MONTHS

18.CLINICAL ASSESSMENT :

1.DEFORMITY

2.JOINT RANGE OF MOVEMENT

3.PRESENCE OF INFECTION

4.X RAYS—time of union

5.TIME OF RETURN TO NORMAL ACTIVITIES

POST OPERATIVE COMPLICATIONS:

1.IMMEDIATE

2.DELAYED

Outcome assessment according to flynn's criteria

Cosmetic factor carrying-angle loss(degrees)

Functional factor movement loss(degrees)

Excellent 0 to 5º 0 to 5º

Good 5 to 10º 5 to 10º

Fair 10 to 15º 10to 15º

Poor >15º >15º