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

Prasad, Avijeet; Mishra, Puneet; Aggarwal, Aditya; Chadha, Manish; Pandey, Rahul; Anshuman, Rahul

doi:10.4103/ortho.ijortho_295_17

Cited by 8 publications

(14 citation statements)

References 25 publications

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“…Mean extension lag of elbow was 7.7° in group 1 and 9.8° in group 2 (P = 0.026); however, it continued to improve in most of the children after 3 months. Thus we believe the outcomes, mostly achieving a stable fixation and long-term postoperative range of movements of both the surgical techniques were nearly the same, which is in accordance with most of the published studies [8][9][10][11][12][13][14].…”

Section: Discussionsupporting

confidence: 89%

“…After preliminary reduction, K-wires were used for definitive fixation under fluoroscopic guidance. For exposed wires, we pierced the skin through a separate stab incision without drilling directly to avoid skin necrosis and subsequent risk of infection [13]. Wires were cut, bent and kept exposed with the ends outside the skin in group 1, and buried under subcutaneous tissue in group 2.…”

Section: Methodsmentioning

confidence: 99%

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Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study

Sahoo¹,

Sahoo²,

Jena

2021

Journal of Pediatric Orthopaedics B

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Buried Kirschner's wires (K-wires) following internal fixation of paediatric Lateral condyle fracture of humerus allow them to hold the bone until radiological consolidation but requires another surgical procedure for implant removal. Exposed wires need meticulous pin tract care, earlier implant removal and may carry a higher risk of infection. The objective of this study was to compare the outcomes of buried versus exposed K-wires for these fractures. This prospective comparative(nonrandomised) study was conducted from July 2016 to April 2020 at a tertiary care level I trauma centre on 80 children, <12 years of age, divided into group 1(n = 40), where K-wires were left exposed, and group 2 (n = 40), where K-wires were buried. Functional outcome and complications were compared between the two groups with at least 3 months follow-up. Infection rate was significantly lower in buried K-wire group with 7 patients (17.5%) compared to 15 (37.5%) in exposed group, P = 0.045. Four out of those 15 patients needed debridement suggesting that exposed K-wires carry a higher risk of bone infection and subsequent morbidities. There was no significant difference in union time, range of motion (mean flexion 135.3° in exposed vs. 132.5° in buried, P = 0.988), carrying angle (8.5° vs. 8.6°, P = 0.981), or lateral condyle hypertrophy; 12 (30%) vs. 9 (22.5%), P = 0.446. Skin pigmentation was more in the exposed group; 13 (32.5%) vs. 10 (25%), P = 0.459. We recommend that K-wires should be buried subcutaneously, particularly when meticulous pin tract care is doubtful.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study

Sahoo¹,

Sahoo²,

Jena

2021

Journal of Pediatric Orthopaedics B

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“…A total of 13 studies met inclusion criteria with a combined total of 1299 patients 14,[17][18][19][20][21][22][23][24][25][26][27][28] (see Table 1). Table 2 shows how many patients and the number of studies were used for each measure.…”

Section: Resultsmentioning

confidence: 99%

Open reduction of pediatric lateral condyle fractures: a systematic review

et al. 2021

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Introduction Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients’ average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence Level 3.

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“…Various studies also reported similar complication and were also managed accordingly. 8,12,19,21 One of theother notable complication of open reduction and internal fixation of lateral condyle fracture is the lateral prominence or the lateral spurring which is a distinct radiological finding and is rarely symptomatic. The development of the lateral spur depends upon the degree of initial fracture displacement, the amount of periosteal dissection done and the stability of fracture fixation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow. Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children. Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al. Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022). Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

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

Cited by 8 publications

References 25 publications

Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study

Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study

Open reduction of pediatric lateral condyle fractures: a systematic review

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

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