How to Prevent K-Wire Bounce in Oblique Supracondylar Humerus Fractures

Iobst, Christopher; Thompson, Robert G.; Grauer, Jordan; Wheeler, Peter

doi:10.1097/bot.0000000000001273

Cited by 9 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute flexion of the elbow causes additional vascular compromise in an already swollen elbow and raises the risk of Volkmann ischemia, whereas anything less than acute flexion threatens decrease loss. This method has been demonstrated that deformity of cubitus varus increased up to 14% that expand the slab from inside and leads to loss of reduction [17,18]. SFH among children frequently cause injury accounting for 16% of pediatric fractures [19].…”

Section: Discussionmentioning

confidence: 99%

Management of Supracondylar Fractures of the Humerous in Children

Khan¹,

Akhtar²,

Ahmad³

et al. 2023

PJMHS

View full text Add to dashboard Cite

Background: Supracondylar humeral fractures (SFH) are the most common fractures of the pediatric elbow, having a peak frequency between the ages of four and nine years. The majority of surgical therapy is percutaneous pinning and closed reduction. The present study aimed to determine the outcome of close reduction and percutaneous pinning in managing the supracondylar humeral fractures in children. Patients and Methods: A total of 64 children presented with supracondylar humeral fractures to the Orthopaedics Unit of Bacha Khan Medical Complex, Swabi during the period from 16th February 2022 to 15th November 2022. Children with supracondylar humerus fractures of completely displaced (Gartland Type III) were enrolled whereas neurovascular injury related to open or closed Gartland type-III fracture were excluded. Under general anesthesia, close reduction was accomplished, and the elbow was immobilized in extension by the implantation of two plaster slabs. The type of fracture, injury pattern, time from injury to final therapy, surgical treatment, and consequences were all recorded. Results: The overall mean age was 4.89±3.2 years. Of the total 64 SFH cases, there were 52 (81.3%) male and 12 (18.7%) females. Out of 52 (81.3%) children with pulseless hands, the incidence of Gartland type III and IV was 15.4% (N=8) and 84.6% (N=44) respectively. Out of 52 cases, there were 19 (36.5%) cold hands and 33 (53.5%) warm hands. The overall mean time between injury and presentation was 3.8±2.4 hours. The incidence of patients undergoing autologous interposition venous grafting, vascular reconstruction, and segmental resection and primary anastomosis was 25% (N=16), 59.4% (N=38), and 15.6% (N=10) respectively. There were no amputations, fasciotomies, re-explorations, or long-term ischemic sequelae. Conclusion: The present study found that close reduction and immobilization with two slabs is a safer and effective method for superior outcome of managing supracondylar humeral fractures in uncomplicated type III injuries as compared to flexion approach. Additionally, Rapid vascular exploration might effectively treat both cold and warm pulseless hands. Keywords: Supracondylar humeral fractures, Management, Children, Close reduction approach

show abstract

Section: Discussionmentioning

confidence: 99%

Management of Supracondylar Fractures of the Humerous in Children

Khan¹,

Akhtar²,

Ahmad³

et al. 2023

PJMHS

View full text Add to dashboard Cite

show abstract

“…Moreover, a two divergent (5-50 degrees) K-wire configuration has more advantage in clinical outcomes. Cadaver investigations of two divergent 60-degree K-wire configurations showed that it failed to obtain bicortical purchase and bounced off the far cortex [39]. The tendency of bending and skidding over the opposite cortex was observed, resulting in the replacement of K-wire with a thicker fixation material [40].…”

Section: Discussionmentioning

confidence: 99%

Finite element analyses of lateral condyle fracture fixation in paediatrics regarding configuration of Kirschner-wire

Jeon

Ahn

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background This study aimed to discover the most stable outcome among different Kirschner-wire (K-wire) configurations for fixation of a lateral condyle fracture (Milch type II) in different loads of stress by using finite element analyses (FEA). Methods The right humerus of a 6-year-old boy with a lateral condyle fracture (Milch type II), was modelled with a computer aided engineering. Using FEA, peak von Mises stress and stiffness were evaluated first for a single K-wire fixation by varying the angle (0, 5, 10, 15, 20, 25, 30 degrees). Then, based on the single K-wire result, assessment of peak von Mises stress and stiffness were evaluated via FEA for two- or three-wire fixation under various configurations (two convergent, two parallel, three divergent). Results Single K-wire fixation by 5 and 25 degrees had the lowest peak von Mises stress. The fracture site showed higher stiffness at 0, 5 and 15 degrees. Considering the collected results and clinical situation, 5 degree K-wire was selected for the FEA of multiple K-wire fixation. For multiple K-wire fixation, three divergent (5–20-35 degrees) K-wires showed better stability, both in peak von Mises stress and stiffness, than any two-K-wire configurations. Among two K-wire fixations, two divergent (5–50 degrees) K-wires provided the lowest von Mises stress in varus and valgus while two divergent (5–65 degrees) K-wires showed better results in flexion, extension, internal and external rotation, and both configurations showed similar results in stiffness. Conclusions We successfully created a paediatric lateral condyle fracture (Milch type II) model which was used to conduct FEA on different K-wire configurations to achieve stability of the fracture. Our results show that an initial K-wire inserted at 5 degrees, followed by the insertion of a second divergent wire at either 45 or 60 degrees provides the most stability in two K-wire fixations in this type of fracture repair.

show abstract

“…Lobst et al have reported that when a smaller diameter wire was used at lower inclinations, the angle of contact with the far cortex may be large causing the wire not to penetrate the cortex and leading to slippage of the wire tip over the endosteal surface of the opposite cortex. A smaller diameter wire might give flexibility during the reduction of fracture fragment, it has a higher chance of breakage, and also it allows it to bounce off the far cortex and travel upwards in the medullary canal without achieving bicortical purchase [ 11 ]. Mechanically, repeated kinking and bending of the K-wire while drilling causes loss of strength, making it weaker and more likely to fracture.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Kirschner Wire Breakage in a Pediatric Supracondylar Humerus Fracture

Ardawatia¹,

Waghela²,

Ranade³

2021

Cureus

View full text Add to dashboard Cite

A displaced supracondylar humerus in a child is usually treated with closed reduction and percutaneous Kirschner (K)-wire fixation. The procedure is straightforward and usually yields excellent outcomes. In general, intraoperative complications are uncommon and intraoperative complications related to K-wires are exceedingly rare. We present the case of intraoperative K-wire breakage while performing closed reduction and K-wire fixation for a pediatric supracondylar humerus fracture. This unusual complication occurred while drilling through the medial cortex and the broken end of the K-wire disappeared under the skin in the cartilaginous distal humerus. The broken wire was removed by making an incision over the broken end. This report serves as a reminder to follow principles of drilling and avoid K-wire-related complications while performing percutaneous fixation of the pediatric supracondylar humerus fracture.

show abstract

How to Prevent K-Wire Bounce in Oblique Supracondylar Humerus Fractures

Cited by 9 publications

References 8 publications

Management of Supracondylar Fractures of the Humerous in Children

Management of Supracondylar Fractures of the Humerous in Children

Finite element analyses of lateral condyle fracture fixation in paediatrics regarding configuration of Kirschner-wire

Intraoperative Kirschner Wire Breakage in a Pediatric Supracondylar Humerus Fracture

Contact Info

Product

Resources

About