Exposed versus buried wires for fixation of lateral humeral condyle fractures in children: A comparison of safety and efficacy

Abstract

Introduction Displaced fractures of the lateral condyle of the humerus are usually treated with open reduction and fixation with smooth Kirschner wires. These may be passed through the skin and left exposed or buried subcutaneously. Exposed wires may be removed in the outpatient clinic, whereas buried wires require a formal procedure under anaesthesia. This advantage may be offset if there is a higher rate of complications with exposed wires. The aim of this study was to compare the safety and efficacy of exposed and buried wires. Study design Retrospective cohort. Methods and materials Children with lateral condyle fractures of the humerus who had undergone surgery were identified from our departmental database. Case records and X-rays of 75 patients were reviewed. Results Forty-two patients had buried wires and 33 had exposed wires. There were no serious complications in either group. In the exposed wires group, 1 patient had a superficial wound infection that was treated effectively with 1 week of oral antibiotics, while 2 patients had hypergranulation of pin tracts treated with topical silver nitrate. None of the patients showed loss of reduction, deep infection, or any other complications requiring additional procedures. Discussion/conclusions There was no statistically significant difference in the rate of complications between the buried and exposed groups. We conclude that open reduction and exposed wiring is a safe and effective option for lateral condyle fractures, and recommend a period of 4 weeks of K-wire fixation followed by 2 weeks of backslab immobilisation as adequate for union with minimal risk of infection.

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

“…A paper by Chan and Siow [13] studied 75 patients and concluded that there was no significant difference in complications with buried versus unburied wires.…”

Buried or unburied K-wires for lateral condyle elbow fractures

“…Chan and Siow compared the 2 treatment options in a retrospective cohort analysis of 42 buried wires versus 33 exposed wires 8 . There was a low complication rate with one superficial infection and two cases of overgranulation, all in the exposed wires group.…”

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

“…However, it is likely that unburied wires might be more prone to pin site infection and a after deep infection. [ 7 ] The duration of unburied fixation for reducing the probability of infection is about 4 weeks; however, a short duration of unburied fixation may provide inadequate time for secure union. [ 15 , 16 ] Conversely, buried K-wires can be left in place until surgeons have explicit radiographic evidence of fracture union.…”

“…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.…”