Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children

Abstract

PurposeSupracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures.MethodsChildren presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury.ResultsAltogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations.ConclusionWe present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

“…Practically, the addition of the Gartland IV-type fracture did not alter the currently recommended method of treatment of the originally described Gartland III-type fractures by means of CRPP. CRPP remains, for most surgeons, the standard treatment for displaced extension type supracondylar fractures of the elbow, whether these fractures are of the Gartland III type or the Gartland IV type [13]. Furthermore, the distinction between the Gartland III and Gartland IV-type fractures is a strict intraoperative finding and cannot be concluded on patient admission.…”

Current Management of Paediatric Supracondylar Fractures of the Humerus

“…More than two wires are sometimes used particularly when fractures are unstable either with three lateral wires or three to four wires in cross wire configuration. It has been shown that fracture reduction is maintained better with three wires in crossed configuration (two lateral and one medial wire) and had a smaller change in Baumann angle compared to those fractures treated with other pin configurations [34].…”

Trombose venosa profunda após uma fratura supracondilar do úmero em uma criança – Uma complicação rara

“…As fraturas supracondilares umerais representam um terço de todas as fraturas pediátricas de membros em crianças com menos de 7 anos de idade, e são uma causa de morbidade significativa na população pediátrica. 1,2 As complicações mais encontradas neste cenário incluem lesões neurovasculares, síndrome compartimental, má consolidação e comprometimento funcional. 1,2 Lesões nervosas e vasculares podem ser iatrogênicas ou podem ocorrer após um evento traumático.…”

“…1,2 As complicações mais encontradas neste cenário incluem lesões neurovasculares, síndrome compartimental, má consolidação e comprometimento funcional. 1,2 Lesões nervosas e vasculares podem ser iatrogênicas ou podem ocorrer após um evento traumático. O comprometimento vascular pode ser causado por ruptura do vaso, torção, compressão, espasmo ou lesão intimal, e a incidência aumenta com o grau de luxação da fratura.…”

“…1,2 The complications most frequently encountered in this setting include neurovascular injuries, compartment syndrome, malunion, and functional impairment. 1,2 Nerve and vascular injuries can be iatrogenic, or they may occur after a traumatic event. Vascular compromise can be caused by vessel rupture, kinking, compression, spasm, or intimal lesion, and the incidence increases according to the degree of fracture dislocation.…”