Systematic Review of Randomized Controlled Trials Comparing Efficacy of Crossed Versus Lateral K-wire fixation in Extension type Gartland type III Supracondylar Fractures of the Humerus in Children

Abstract

Supracondylar fractures of the humerus occur frequently in children and account for approximately 70% of all elbow fractures. The aim of this systematic review is to critically appraise randomized controlled trials in the literature comparing the outcome of surgical treatment of extension type Gartland III supracondylar fractures using either a cross pin configuration or lateral pins only for fixation in terms of the stability of fixation and the incidence of encountered complications. Only 4 randomized trials were found over the past 10 years. These were reviewed according to the CONSORT 2010 check list. No study found any significant statistical difference in terms of loss of reduction between the two groups, suggesting similar stability of both constructs. There is currently, however, no Level 1 evidence comparing the outcome of crossed pinning versus lateral entry pinning in extension type Gartland III supracondylar fracture. Additionally, the current highest level evidence discussed above has limitations ranging from small sample size to insufficient data on clinical outcome. Therefore we cannot draw any firm conclusions on the above evidence. We suggest that future RCTs take into account the recent evidence on fixation by including three lateral pins and larger diameter pins in their cohorts.

Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

“…These results are consistent with previous literature. 12,14,16 In our study, the fractures are more common on left side as observed i.e. 58% in total of patients (60% in group 1 and 56% in group 2).…”

“…These results were also more common in previous studies. 14,16,17 In the present study, 72% of total cases had mode of injury as fall from height among group 1, as compared to 64% among group 2. Remaining cases had injury because of fall from bicycle, fall from bike and fall while playing, all these mode of injury involved mechanism of fall from height with extended elbow.…”

“…In particular, incidence peaks between the ages of 5-7 have been reported. 12,14,15 Supracondylar fractures of humerus are common in boys compared to girls. In our series, 72% were boys and 28% were girls.…”

Open reduction and pinning for the treatment of Gartland extension type III supracondylar humeral fractures in children

“…Supracondylar fractures of the humerus in children are more common under the age of 10. In particular, incidence peaks between the ages of 5–7 have been reported [4–6]. In our series, the age distribution is from 2 to 14.…”

“…Surgical procedures are the treatment of choice in displaced supracondylar humerus fractures [2]. Humerus fractures are a significant part of pediatric fractures due to high incidence, high morbidity, and serious complications [3, 4]. …”