Buried or unburied K-wires for lateral condyle elbow fractures

Abstract

INTRODUCTIONLateral humeral condyle fractures typically require a longer period of internal fixation than other distal humeral fractures due to the increased risk of non-union. K-wires can be buried and left in situ until union or they can be left unburied and require removal after four weeks, with plaster immobilisation until union. There is no consensus as to whether wire burial is preferable or not. The aim of this study was to determine whether K-wire burial is associated with more complications than non-buried wires in treating lateral condyle fractures of the elbow.METHODSAll patients with lateral humeral condyle fractures treated with K-wire fixation at our institution from May 2008 to August 2011 were included in the study. Fracture configuration, mode of reduction, wire burial and complications were assessed.RESULTSSixty-seven patients (19 girls and 48 boys, mean age: 6.5 years, range: 1–17 years) were included in the study. All had closed injuries and were treated with open reduction and K-wire fixation. K-wires were buried in 55 patients. Thirteen cases of buried wires eroded through skin and were removed on average 45 days (range: 30–58 days) post-operatively. Of the wire erosion cases, three developed microbiologically proven infections, one of which was a deep infection. There were a further three superficial wound infections in the absence of wire erosion through the skin. There were complications in 2 of the 12 cases in the unburied wires group: 1 microbiologically proven superficial wire site infection and 1 wire backed out after 11 days, requiring refixation.CONCLUSIONSWire erosion through the skin is the most common complication of K-wire burial. This may be due to the decrease in swelling after fracture fixation, making the wires more prominent under the skin. Skin integrity should be monitored closely if wires are buried.

Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures

“…They concluded that leaving the K-wires unburied was safe and more cost effective than using buried wires. However, similar to our previous study [10], the vast majority of the patients were managed with buried wires. Our current study included much more comparable patient numbers, with 60 in the buried and 64 in the unburied group, with a greater potential to show a true difference between the groups.…”

“…A previous study at our institution [10] noted problems surrounding skin erosion following the routine use of buried wires. This led to a change in practice, such that unburied wires were preferably used.…”

Toxic shock syndrome post open reduction and Kirschner wire fixation of a humeral lateral condyle fracture

“…All the K-wires were unburied in their study. One study looking at buried as well as unburied K-wires in lateral condyle fractures found a higher rate of infection in the buried K-wire group 2. It is difficult to say whether burying or not burying the K-wires has any impact on the development of infection or more specifically the development of TSS, but it should be considered.…”

“…Displaced fractures often require open reduction and internal fixation. Use of Kirschner wires (K-wires) is the most common method of fracture stabilisation in lateral condyle fracture fixation in children 2. Complications of K-wire usage include failure of fixation, wire breakage, infection and migration 3…”

Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

“…But it has been generally accepted that the displaced fractures should be treated with open reduction so as to achieve the near anatomical alignment. [10][11][12][13] Smooth Kirschner wires (K-wire) are the most commonly used metallic implants for fixation of the fracture. 8,14 But this fixation requires an additional immobilization with a plaster splint or a cast for four to six weeks.…”