[Case-control study on therapeutic effects of different fixation methods with three Kirschners wires for the treatment of humeral supracondylar fractures]

Abstract

Objective: To compare therapeutic effects of three fixation methods with three Kirschner wires,and to find the best fixation method.

Methods: From July 2008 to May 2009, 60 patients with humeral supracondylar fractures were treated. Among patients in Group A, 11 patients were male and 9 patients were female, ranging from 2 to 13 years old,with an average of (5.4 +/- 0.5)years;all the patients in Group A were fresh closed fractures without nerve and blood vessel injuries, 13 patients were type II and 7 patients were type III according to Gartland classification; and all the patients in Group A were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through radial edge of coronoid fossa. Among patients in Group B, 13 patients were male and 7 patients were female,ranging from 2 to 11 years old, with an average of (6.1 +/- 0.4) years; all the patients in Group B were fresh closed fractures without blood vessel injuries, 11 patients were type II and 9 patients were type III according to Gartland classification, 2 patients had ulnar nerve injuries before treatment; and all the patients in Group B were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through ulnar edge of coronoid fossa. Among patients in Group C, 8 patients were male and 12 patients were female, ranging from 3 to 14 years old, with an average of (7.4 +/- 0.6) years; all the patients in Group C were closed fresh fractures without blood vessel injuries, 7 patients were type II and 13 patients were type III according to Gartland classification, 2 patients had radial nerve injuries before treatment; and all the patients in Group C were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through middle of coronoid fossa. After 1 year of treatment,the Carrying and Baumann angles were measured on the X-ray of all patients in the three groups, and the motion range of elbow joint was observed. The Flynn evaluation criteria were used to compare therapeutic effects among the three groups.

Results: All the patients were followed up. The function loss of elbow joint were (14.04 +/- 3.25) degrees in Group A, (13.14 +/- 2.34) degrees in Group B, and (9.25 +/- 2.56) degrees in Group C. Changes of Carrying angle were (7.64 +/- 1.78) degrees in Group A; (7.38 +/- 1.68) degrees in Group B, and (5.27 +/- 1.13) degrees in Group C. Changes of Baumann angle were (28.55 +/- 3.23) degrees in Group A, (27.55 +/- 2.23) degrees in Group B, (21.45 +/- 1.73) degrees in Group C. According to Flynn criteria, there were 11 patients got excellent result, 4 good and 5 poor in Group A; in Group B, 12 patients got excellent result, 3 good and 5 poor; in Group C, 11 patients got excellent result, 6 good and 3 poor. The therapeutic effects of Group C was better than those of Group A and Group B.

Conclusion: There are different effects among three kinds of operative approaches for the humerus supracondylar fractures. The fixation method with one Kirschner wire through middle part of coronoid fossa is better than the other two fixation methods.