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

Abstract

There is little consensus on whether Kirschner wire (K-wire) burial is preferable in the management of paediatric lateral humeral condyle fractures. We identified 124 patients from May 2008 to August 2014. Sixty received buried K-wires and 64 received unburied wires. We found no significant difference in the infection rates between groups, but a high rate of skin erosion (23%) in the buried group, with a subsequent high rate of infection in this subgroup (40%). We found a strong association of wire erosion following early surgery. There is a considerable cost saving associated with using unburied wires. We therefore recommend the routine use of unburied wires.

Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures

“…Demographic characteristics and details concerning the literature type of the included studies are summarized in Table 2 . [ 7 , 16 – 18 ] Statistically similar baseline characteristics were observed between both groups. All studies had small sample sizes, from 67 to 235 patients.…”

“…In our study, Das De and Ormsby [ 17 , 18 ] report that unburied wires would evidently impart cost-savings compared with buried wires. Higher postoperative infection occurred among the 56 patients with distal radius fractures in the unburied K-wire group according to Hargreaves’ [ 32 ] prospective randomized study, and he recommends a buried fixation duration of more than 8 weeks in spite of higher cost.…”

“…However, some clinical studies did not provide statistical data. Four non-RCTs [ 7 , 16 – 18 ] ultimately met the inclusion criteria for the meta-analysis without high quality RCTs. All these shortcomings weaken the level of evidence for the current study.…”

“…Several studies comparing the outcome between buried and unburied K-wires have been published in past years. [ 7 , 16 – 18 ] However, there is no clear consensus as to whether K-wires should be buried or left unburied outside the skin. Consequently, we performed a meta-analysis concerning buried or unburied internal fixation treatment of lateral condyle distal humeral fractures in children to provide evidence for making a clinical decision.…”

Exposed versus Buried Kirschner Wires Used in Displaced Pediatric Fractures of Lateral Condyle of Humerus

“… 12 Literature specifically comparing the results and complications with exposed versus buried K-wires after open reduction of lateral condyle fractures is scarce and mainly from western population. 12 15 16 Moreover, these studies are retrospective. India is a tropical nation where a lack of general hygiene condition along with economic and climate conditions may lead to high chances of pin tract infection.…”