Lateral entry pins and Slongo’s external fixation: which method is more ideal for older children with supracondylar humeral fractures?

Abstract

Objective The standard surgical treatment for supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Given the need for greater fixation strength and higher risk of joint stiffness for children older than 8 years, external fixation is often performed for treating supracondylar humeral fractures in older children. The aim of this study was to compare the efficacy of lateral entry pins and Slongo’s external fixation for treating supracondylar humeral fractures in older children. Methods Children older than 8 years who underwent surgery for supracondylar humeral fractures at our hospital for surgery from January 2016 to December 2020 are to be retrospectively assessed. One group (n = 36) underwent internal fixation and percutaneous pinning with three lateral Kirschner wires, and the other group (n = 32) underwent Slongo’s external fixator surgery. The demographic data, operation duration, number of fluoroscopies, and fracture healing time were compared between both groups. The elbow joint function was evaluated 6 months after the surgery on the basis of fracture healing time, lifting angle, elbow joint range of motion (ROM), and Flynn score. The incidence of postoperative complications was also recorded. Results There was no significant difference between the two patient groups in terms of the demographic parameters. Compared to external fixation surgery, Kirschner wire surgery required shorter duration and fewer fluoroscopies (P < 0.05). Nevertheless, the fracture healing time was significantly less (P < 0.05), and the elbow ROM and Flynn scores were higher in the external fixator group compared to the Kirschner wire fixation group (P < 0.05). There was one case of secondary fracture displacement in the Kirschner wire group and one of pin tract infection in the external fixator group. No other iatrogenic injuries or complications were observed. Conclusion Maybe Slongo’s external fixator is a suitable alternative treatment option for supracondylar humeral fractures in children older than 8 years since it can achieve better fixation strength and early restoration of elbow joint movement with a lower risk of joint stiffness.

Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents

“…In conclusion, the presented radiographic and photographic clinical evidence provided by He et al [1,4] and Slongo et al [6,7] indicates to us that Slongo's external fixation technique is not as simple as it was described, with there being a mismatch between the presented radiographic mal-reductions and poor photographic clinical findings and the reported good outcome data, which does not support that the use of external fixation for the management of supracondylar humerus fractures is easier and superior compared to K-wire fixations. The data do also not support that He et al 's [1] very labour-intensive ultra-early rehabilitation results in better outcomes compared to self-rehabilitation.…”

“…He et al [1] provided intra-operative post-fixation radiographs show rotational fracture malalignment with displacement of the medial column as seen in the authors' [1] images G and H. He et al [4] previously provided radiographs and clinical photographs of a different external fixation child, showing a large radiographic extension deformity after fixation with marked loss of elbow flexion, loss of extension and loss of normal carrying angle, which we would grade as a poor outcome based on the Flynn criteria [5], but the authors [4] did not recognize it as such.…”

“…He et al [4] previously presented a comparison between a K-wire and an external fixator group, not mentioning a rehabilitation program for either group. He et al [1,4] reported exactly the same data (means and standard deviations) in both publications for age, weight, height, admission to surgery time and length of hospital stay for the K-wire group [4] and C-group [1] and external fixator group [4] and R-group [1], respectively, despite the K-wire-and C-group and the R-and external fixator group containing different numbers of patients.…”

“…He et al [4] previously presented a comparison between a K-wire and an external fixator group, not mentioning a rehabilitation program for either group. He et al [1,4] reported exactly the same data (means and standard deviations) in both publications for age, weight, height, admission to surgery time and length of hospital stay for the K-wire group [4] and C-group [1] and external fixator group [4] and R-group [1], respectively, despite the K-wire-and C-group and the R-and external fixator group containing different numbers of patients. Such an exact match of multiple data is only possible, if both publications include data from the same groups, which would mean that the K-wire [4] and external fixator control group [1] data are from the same group (the same applies to the external fixator group [4] and rehabilitation external fixator group [1]), indicating that there has been an extensive data transcription error, which would invalidate the results and conclusions of the paper.…”

Lateral entry pins and Slongo’s external fixation: which method is more ideal for older children with supracondylar humeral fractures?

“…We read with interest the recent publication by He and colleagues [1]. The authors reported that there was no significant difference between the groups in terms of clinical characteristics despite a huge difference in body mass index (BMI), with the K-wire group having a normal mean BMI of 22.4 and the external fixator group being obese with a mean BMI of 30.3.…”