Displaced supracondylar femoral fractures: Clinical and radiographic outcomes in children aged 4-10 years treated with Kirschner wires and hip spica cast

Abstract

Background: Supracondylar femoral fractures (SFFs) are uncommon in children but can cause several abnormalities. Although several methods have been employed to treat these fractures, no accepted standard has been established.

Objectives: To investigate the clinical and radiographic outcomes of displaced SFFs treated with Kirschner wires (K-wires) and hip spica casts in children aged 4-10 years.

Methods: We retrospectively reviewed 22 displaced SFFs (mean age, 6.7 years; range, 4-10 years) in patients who underwent surgical treatment with K-wires and hip spica casts. The patients were followed-up frequently, radiographically and clinically between January 2014 and February 2019. Postoperative healing and functional results were elevated according to the radiographic and clinical measures.

Results: Fifteen boys and seven girls were included in this study. All patients except two (91%), underwent closed reduction and stabilization of the fractures. The mean follow-up duration was four years (range, 2-5 years). All fractures showed clinical and radiological evidence of union 4-8 weeks after surgery. At the most recent check-up, all patients reported being pain-free and had returned to normal activities. The mean Knee Society Score was 95.41 at the final follow-up. According to the radiologic criteria, 18 of the 22 patients (81.8%) obtained excellent results, 3 (13.6%) had good results, 1 (4.5%) had a fair result, and none had poor results.

Conclusion: Satisfactory clinical and radiological results can be expected in children aged 4-10 years using a combination of K-wires and hip spica cast fixation.

Keywords: Kirschner wire; displaced; hip spica cast; pediatric; supracondylar femoral fractures.

Figure 1

Outcome in a 4-year-old girl with a displaced supracondylar femoral fracture. Anteroposterior (A) and lateral radiographs (B) obtained before surgery. Intraoperative anteroposterior (C) and lateral radiographs (D). Anteroposterior (E) and lateral radiographs (F) obtained 1 month after surgery, and showing the fracture has healed. Anteroposterior (G) and lateral radiographs (H) obtained 1 year after surgery, which showed limb alignment was normal and epiphyseal development was normal.

Figure 2

A 9-year-old boy, treated with Kirschner wire internal fixation followed by a one-and-one-half spica plaster cast.