Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring

Abstract

Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture.Materials and Methods: A total of seven children with irreducible Gartland Type III supracondylar humeral fracture were treated with closed reduction and lateral external fixation and lateral Kirschner wiring. Patients with ipsilateral radial or ulnar fracture, open fracture and presence of neurovascular impairment pre-operatively were excluded. All the patients were followed up at one, three and six weeks and three and six months. The final outcomes were assessed based on Flynn’s criteria.Results: All the patients achieved satisfactory outcomes in terms of cosmetic and functional aspects. All patients except one (85.5%) regained excellent and good cosmetic and functional status. One patient (14.3%) sustained pin site infection which resolved with oral antibiotic (Checketts- Otterburn grade 2). There was no neurological deficit involving the ulnar nerve and radial nerve.Conclusion: The introduction of lateral external fixation and lateral percutaneous pinning provide a promising alternative method for the treatment of humeral supracondylar fracture. This study demonstrates that it has satisfactory cosmetic and functional outcomes with no increased risk of complications compared to percutaneous pinning.

Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

“…The study results reflected a lack of significant differences between the two methods with respect to movement and function, with apparently less scarring and soft tissue trauma in the external fixator technique. In our view, both the clinical and radiographic outcomes correspond with earlier data that demonstrated satisfactory range of motion in almost all patients who underwent closed reduction and external fixation, as well as excellent cosmetic results 23,24 and no postsurgical neurovascular damage. These studies, along with ours, support the optional use of the external fixator technique.…”

“…This group reported very satisfying results, but their approach has been scarcely described since. 24…”

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

“…In as much as multiple clinical studies have shown satisfactory results with EF [8,20] overall, the technique was found to be the weakest in two of our fracture models. Hohloch et al in an earlier study found EF with ulnarly placed K-wire to be more stable than crossed pinning in internal rotation [21,22] and therefore recommended insertion of an additional ulnarly antirotation K-wire instead of a radial one in cases of pediatric SHFs when an external fixator is used for osteosynthesis, because this may reduce secondary displacement of the distal fragment.…”