Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

There is little consensus on whether Kirschner wire (K-wire) burial is preferable in the management of paediatric lateral humeral condyle fractures. We identified 124 patients from May 2008 to August 2014. Sixty received buried K-wires and 64 received unburied wires. We found no significant difference in the infection rates between groups, but a high rate of skin erosion (23%) in the buried group, with a subsequent high rate of infection in this subgroup (40%). We found a strong association of wire erosion following early surgery. There is a considerable cost saving associated with using unburied wires. We therefore recommend the routine use of unburied wires.

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“…Lateral humeral condyle fractures are a common injury in children [1]. They account for between 12 and 20% of all elbow fractures [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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

Ormsby

Walton²,

Robinson³

et al. 2016

Journal of Pediatric Orthopaedics B

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“…Of the ten studies, eight reported outcomes of K-wire fixation, [19][20][21][22][23][24][25][26][27][28] four reported the outcomes of screw fixation, 21,27,20,24 one reported outcomes of fixation with bioabsorbable materials 19 and one of screw-wire fixation. 28 In addition, three studies looked exclusively at closed reduction.…”

Section: Resultsmentioning

confidence: 99%

“…Primary Outcome -Functional Outcomes K-wire fixation had excellent functional outcomes in 52% 28 to 100% 19 of patients. Screw fixation had excellent functional outcomes in 89% 27 to 100% 20 of patients.…”

Section: Resultsmentioning

confidence: 99%

<p>Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review</p>

Birkett

Al-Tawil

Montgomery

2020

ORR

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Objective: Lateral humeral condyle fractures are the second most common elbow fractures in children. Both K-wire fixation and screw fixation have been advocated as suitable treatment options for displaced fractures. This study aimed to identify which fixation method was associated with the best functional outcomes. Methods: A systematic review was conducted. Studies reporting functional outcomes following surgical fixation of lateral condyle fractures were included for review. The primary outcome measure was functional outcome. The secondary outcome measure was major complications. A narrative analysis was undertaken, as meta-analysis was felt to be inappropriate due to the differences between included studies. Results: Ten retrospective non-randomised, comparative studies were eligible and included. No randomised-controlled trials were identified. The highest rate of excellent functional outcomes was seen with screw fixation (120/126 [95%]), compared with K-wire fixation (135/162 [86%]). The incidence of major complications was comparable, with complications in 6/95 (6%) of screw fixations and 6/141 (4%) K-wire fixations. A small sample of data on closed reduction demonstrated excellent functional results in 73 of 76 (96%) of patients. Closed reduction of displaced fractures is associated with a significant learning curve however. Conclusion: The evidence was of poor quality and comprised of retrospective case series. This prevented meta-analysis and any firm conclusions being drawn from the available data. Screw fixation may be associated with improved functional outcomes. Complication rates between the two methods are comparable. Further prospective studies are recommended.

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“…[10][11][12][13] Smooth Kirschner wires (K-wire) are the most commonly used metallic implants for fixation of the fracture. 8,14 But this fixation requires an additional immobilization with a plaster splint or a cast for four to six weeks. Few recently published reports suggest the use of cannulated cancellous (CC) screws for fracture fixation as it provides compression at the fracture site and is a more stable construct.…”

Section: Comparison Of Kirschner Wires and Cannulated Screw Internal mentioning

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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Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

Cited by 22 publications

References 22 publications

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

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

<p>Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review</p>

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

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