A comparison between percutaneous cross k wire and lateral k wires fixation in management of Type III Gartland paediatric supracondylar fractures

Abstract

Introduction: Supracondylar humerus fractures are one of the commonest fractures in the paediatric age group. Displaced fractures of these kind, that is, Gartland type III are treated by closed or open reduction and k wire fixation. Cross k wire and lateral wires are the commonest configurations used for fixation. The present study aims to evaluate the difference between the two configurations in terms of surgical technique, functional outcome and complications. Materials and methods: A prospective study of 30 paediatric patients with displaced Supracondylar humerus fractures was carried out between September 2016 to September 2017. 15 patients were treated with cross k wire fixation (Group A) while the rest with 2 lateral k wires (Group B). The functional outcome of the 2 groups was measured by Flynn's criteria. Also, the intra operative difficulties and iatrogenic ulnar nerve palsy were noted. Statistical analysis between the two groups was done by Student's t-test to find any statistical significant difference. Results: As per Flynn's criteria, 66.67 % patients treated with cross k wire fixation and 60.00 % patients treated with lateral k wires had excellent functional outcome. This difference was not statistically significant. 3 patients in group A had ulnar nerve palsy which resolved within 3 weeks after surgery. No incidence of ulnar nerve palsy was found in patients of group B. Conclusions: There is no statistical difference between the two techniques with respect to functional outcome indicating that both methods are equally efficient. However, there is a risk of ulnar nerve palsy during insertion of the medial wire of the cross k wire fixation.

Outcome analysis of cross pinning in supracondylar fractures of humerus in children

“…At the final follow up, the results were analysed according to Modified Flynn's criteria. In our study, 30 out of 30 patients had satisfactory results which is comparable with Palange et al [18] study.…”

Medial–lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: a meta-analysis of randomized controlled trials

“…Ten studies recruited only Gartland type III fractures, eight enrolled both Gartland type II and III fractures, and one included Gartland type II, III and IV fractures [ 23 ]. Six RCTs allowed the use of a third pin if required [ 23 , 25 , 28 , 29 , 34 , 36 ], while seven trials used a medial mini-open technique [ 22 , 24 , 25 , 27 , 30 , 37 , 38 ]. The follow-up widely ranged from 1.8 to 11.43 months.…”

“…Five RCTs without reporting the randomization procedure were considered to have unclear risk, and the other ten trials had low risk of such bias. Five studies reported proper allocation concealment [ 26 , 27 , 30 , 37 , 38 ]. Patients in three trials [ 26 , 27 , 30 ] and researchers assessing outcomes in six trials [ 22 , 26 , 27 , 30 , 34 , 40 ] were not blinded to interventions.…”

“…S6). Among seven studies using the mini-open technique [ 22 , 24 , 26 , 27 , 30 , 37 , 38 ], only 2.2% (5/230) of patients in MLP group suffered ulnar nerve injury, which did not differ from that in LP group (RR = 1.73, 95%CI 0.47–6.31, P = 0.407). However, in patients treated with crossed pin fixation but without using the mini-open technique, the incidence of ulnar nerve injury was 5.4% (17/312), which was significantly higher than 1.3% (4/305) in LP group (RR = 2.44, 95%CI 1.08–5.51, P = 0.032).…”

“…The literature search identified a total of 327 unique articles after removing duplicates. Finally, 19 RCTs comprising 1297 children with SCHF were included in current meta-analysis [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (Fig. 1).…”