Supracondylar Fractures of the Humerus in Children: Dorgan’s Lateral Cross-wiring 이대목동병원 윤 여 헌

Pin Configurations 2 lateral pinsMedial-lateral crossed pins

Pin Configurations 2 lateral pins & 1 medial crossed pin Shim & Lee (JPO, 2002) 3 lateral pins Lee et al (JPO, 2008)

Biomechanics Lee et al (2002): divergent lateral > parallel Larson et al (2006): 2 lateral 1 medial cross - strongest Bloom (2008): 3 rd pin in malreduced fractures

“Dorgan’s” Percutaneous Lateral Cross-Wiring Shannon et al (JPO, 2004) –20 supracondylar fx, types II (2), III (18) –All excellent result –No complication Stability Safety

Dorgan’s lateral cross-wiring -materals & method- In 2008 –35 operated supracond fx 23 Dorgan’s cross-wirings –G II (9) varus impacted (6) medial comminution (3) –G III (12) –Flexion type (2) 2 pins (3), 3 pins (20)

Dorgan’s lateral cross-wiring - materals & method - 23 supracondylar fx –2 pins (3), 3 pins (20) –CR & percutaneous (21), OR (2) –Long arm cast for 3 wks –Pins removed at 3 wks

Dorgan’s lateral cross-wiring - results - 23 cases Well maintained (17 cases) –8/9 G II –7/12 G III –2/2 flexion type Complicated (6 cases) –Minimal rotation, no pin problem 2/12 G III –Proximal pin malposition-migration 3/12 G III –Pin site infection requiring earlier pin removal (only at the proximal pin) 2 cases

Dorgan’s lateral cross-wiring - results - Outcomes at the last FU –4~9 months (avg 4.8 m) –Carrying angle, ROM, function, complication –“excellent to good” in all cases –Proximal pin problems did not influenced the final outcome

Case ( 박 00, f/2) G II, varus impacted

5 days

proximal pin migrated to be removed under GA

Case ( 유 00, M/2) G III supracondylar fx

3 wks

Case ( 이 00, M/10) G III supracondylar fx

5 days

Case ( 김 00, F/4) G III supracondylar fx

7 days

Summary Dorgan’s lateral entry cross-wiring 23 supracondylar fx Problems in 6 cases –Minimal rotation without pin problem (2) –Proximal pin malposition- migration (3) –Infection arround the proximal pin (2) Excellent-good final result in all cases Placing the proximal pin –Technically demanding –Engagement of distal fragment Not easy Not confirmative esp. in youngest child Requires anatomical reduction

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