K-wire Versus Screw Fixation in Displaced Lateral Condyle Fractures of the Humerus in Children: A Multicenter Study of 762 Fractures

Abstract

Introduction: Lateral humeral condyle fractures account for 12% to 20% of all distal humerus fractures in the pediatric population. When surgery is indicated, fixation may be achieved with either Kirschner-wires or screws. The literature comparing the outcomes of these 2 different fixation methods is currently limited. The purpose of this study is to compare both the complication and union rates of these 2 forms of operative treatment in a multicenter cohort of children with lateral humeral condyle fractures. Methods: This retrospective study was performed across 6 different institutions. Data were retrospectively collected preoperatively and 6 weeks, 3, 6, and 12 months postoperatively. Patients were divided into 2 cohorts based on the type of initial treatment: K-wire fixation and screw fixation. Statistical comparisons between these 2 cohorts were performed with an alpha of 0.05. Results: There were 762 patients included in this study, 72.6% (n=553) of which were treated with K-wire fixation. The mean duration of immobilization was 5 weeks in both cohorts, and most patients in this study demonstrated radiographic healing by 11 weeks postoperatively, regardless of treatment method. Similar reoperation rates were seen among those treated with K-wires and screws (5.6% vs. 4.3%, P=0.473). Elbow stiffness requiring further intervention with physical therapy was significantly more common in those treated with K-wires compared with children treated with screws (21.2% vs. 13.9%, P=0.023) as was superficial skin infection (3.8% vs. 0%, P=0.002), but there was no significant difference in nonunion rates between the two groups (2.4% vs. 1.3%, P=1.000). Conclusion: We found similar success rates between K-wire and screw fixation in this patient population. Contrary to previous studies, we did not find evidence that treatment with screw fixation decreases the likelihood of experiencing nonunion. However, given the unique complications associated with K-wire fixation, such as elbow stiffness and superficial skin infection, the treatment with screw fixation remains a reasonable alternative to K-wire fixation in these patients. Level of Evidence: Level III—retrospective comparative study

K-wire versus screws in the fixation of lateral condyle fracture of humerus in pediatrics: a systematic review and meta-analysis

“…Comparative studies on K-wire fixation and screw fixation have been published [ 19 – 22 , 34 – 38 ]. An abstract was reported as the first study to compare K-wire and screw fixation in lateral condyle fractures, and the results showed no difference between the groups [ 38 ].…”

“…Two studies [ 34 , 36 ] also compared the outcomes between K-wire and screw fixation in lateral condyle fractures in children, but they were excluded from the quantitative analysis because they included patients with nondisplaced and minimally displaced fractures. These studies also reported improved outcomes in the screw-fixation group.…”

“…Lower rates of nonunion and superficial infection were reported in the screw fixation group. Cummings et al [ 34 ] included 762 patients from six different institutions; 553 patients were in the K-wire fixation group, and 209 patients were in the screw fixation group. The nonunion rate did not differ between the groups, but superficial infection and elbow stiffness were statistically higher in the K-wire fixation group.…”

What’s New in Pediatric Orthopaedics

“…In a study comparing supracondylar humeral fractures treated within 18 hours of presentation with those treated after 18 hours, there were no differences in outcomes including malunion, nonunion, stiffness, infection, or nerve injury 1 . In a multicenter study of 762 patients with displaced lateral condyle fractures of the humerus treated with either Kirschner wires or screws, the nonunion and reoperation rates were similar, but elbow stiffness requiring therapy and superficial skin infections were more common in the Kirschner wire cohort 2 . The authors suggested that screw fixation is a reasonable alternative to Kirschner wire fixation, although follow-up was limited to 1 year.…”