Newcastle approach for the treatment of supra-intercondylar
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Newcastle approach is an alternative to perform open reduction in those children supra-intercondylar fractures that cannot be reduced using a close reduction.

Case 1

A 7-year old girl referring pain and functional impairment in the right elbow after a casual fall from her stand height. She had a painful right elbow held in 80° of flexion, unable to move actively without any Neurovascular deficit. The radiological study (antero-posterior and lateral elbow view) revealed a displaced supra-intercondylar humeral fracture . In the operating room, with fluoroscopy images and under general anesthesia, this fracture pattern was confirmed. Open reduction of the fracture was performed, following the Newcastle posterior approach, and subsequently internal fixation with four 1.8 mm Kirschner wires (K-wires). The elbow was immobilized at 90° with a brachial palmar splint.

Case 2

An 8-year-old girl, reporting severe pain and functional impairment of her left elbow after a horse fell. On examination, the patient presented significant swelling and bruising in the left elbow, without a neurovascular deficit of the limb. In the radiological study (antero-posterior X-ray) a supracondylar fracture was diagnosed. In the operating room, under general anesthesia, the closed reduction of the fracture was not successful, and the surgeon opted for an open treatment. A Newcastle approach was performed, which gave evidence that apart from the supracondylar fracture, there was also a non-displaced intercondylar line. The supracondylar fracture was reduced and stabilized using internal fixation with three 1.8 mm K-wires. Since the intercondylar fracture line was stable and did not move with the surgical manipulation, no stabilization K-wires were added to that plane.

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