Burnei’s „double X“ osteosynthesis in humeral supracondylar fractures in children
Authors:   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică, Ghiţă Raluca ,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Gavriliu Ştefan ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Georgescu Ileana ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Pârvan Adrian ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Japie Ecaterina ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Macadon Mădălina ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti, Marica Andrei ,   Grupul de Studii şi Cercetări în Ortopedia Pediatrică – 2012 Clinica de Ortopedie Pediatrică,   Spitalul Clinic de Urgenţe pentru Copii „Maria Sklodowska Curie“, Bucureşti
Published: September 2021

Pediatric Orthopaedics Group for Research and Study – 2012 has initiated this retrospective analysis because in Romania, but also in other countries, the therapy procedures, although in great number, do not provide practicing physicians with a clear orientation according to certain therapeutic criteria in the treatment of supracondylar fractures of the humerus. As a consequence, the number of complications and their severity have drawn attention over existing lack of knowledge in the medical or surgical act. To correct complications, valgus and varus elbow, Prof. Al. Pesamosca announced an original operation entitled „Personal method in correction of varus post-traumatic elbow“ in Bacau County Meeting of 24 June 1978. This operation was later popularized by Gh. Burnei & al. with surgical interventions in patients with varus or valgus post-traumatic elbow and then presented at several congresses in the country and abroad. The last work that addressed this subject was presented at the 29th Annual Congress of the European Pediatric Orthopedic Society (EPOS) from 7 to 10 April 2010, Zagreb, Croatia, and is entitled „Distal humeral Z-osteotomy for posttraumatic cubitus varus or valgus“ having authored by Gh. Burnei, Ileana Georgescu, Stefan Gavriliu, Costel Vlad and Daniela Dan. As members of this group, based on studies we made, we want to popularize a new type of osteosynthesis, which ensures a snug fit, avoids complications, and allows rapid recovery after surgery. The best approach to this kind of fractures is orthopedic and must be carried out urgently, in the first 6 hours by reduction and immobilization in a cast, or by closed or open reduction with fixation using multiple methods (Judet, Boehler, Kapandji, San Antonio, San Diego, double-X Burnei). Open treatment is necessary in supracondylar irreducible, reducible and unstable fractures, in supracondylar fractures occurring within multiple accidental trauma, in fractures with vascular complications, in unreasonably delayed, fractures, in orthopaedically managed fractures which have displaced under cast, or in surgically treated fractures where fixation is damaged. We use Burnei technique for about 10 years. Here in Romania, great work has been done in this field by Al. Pesamosca, D. Vereanu, Ionel Ionescu, N. Negus, Pompiliu Parota, T. Zamfir, Gh. Burnei, I. Hutanu, etc. Abroad, important papers on the treatment of supracondylar fractures of the humerus have been published by L. Böhler, A. Kapandji, K. Wilkins, D. Skaggs, E. Edomnds, E. Swanson, etc. Between October 2001 and October 2011 in „Alexandru Pesamosca“ Surgery Clinic, 56 cases have been resolved with the help of Burnei’s „double-x“ osteosynthesis. These patients were operated using Kocher type unique approach, the intervention beeing primarily aimed at providing osteosynthesis that is not followed by immobilization in a cast and also enabling mobilization 24 hours after surgery. Wires placed in „double-X“ should not sit olecranon fossa. Immobilization must be anatomical and olecranon fossa must be free. After surgical intervention, check elbow flexion and extension which should be normal, without providing crackles or limitations. This intervention was done in patients: having secondary displacement in plaster after 10 days of immobilization; with other types of damaged osteosynthesis; with polytrauma with supracondylar fracture; who neglected or unjustifiedly delayed fractures that were not orthopaedically reduced in emergency and had swelling and blistering. Using Burnei’s „double-X“ osteosynthesis in supracondylar humerus fractures, does not require cast immobilization. In oblique trajectory fractures, the stability of the fracture by reduction, with or without wiring, is ensured more difficultly and often followed by joint stiffness and/or ulnar nerve paresis. Burnei’s „double-X“ osteosynthesis provides stability to such fractures and avoids complications. Mobilization of the elbow may begin immediately after surgery. The process provides comfort to the patient and doctor and if multiple injuries require repeated exams, preferred positions or care of extensive lesions of the skin.