How Kirschner Wires Crossing Each Other at the Fracture Site Affect Radiological and Clinical Results in Children With Gartland Type 3 Supracondylar Humerus Fractures?

Abstract

Background In this study, we compared two groups of children with Gartland Type 3 supracondylar humerus fractures with respect to the crossing point of Kirschner wires (K-wires) in terms of radiological and clinical results after closed reduction and fixation with the crossed-pin technique. We hypothesized that even if medial and lateral pins cross each other at the fracture line, satisfactory radiological and clinical results would be achieved with the crossed-pin technique. Methodology A total of 59 patients with Gartland extension Type 3 supracondylar humerus fractures who underwent closed reduction and percutaneous crossed-pin fixation were included in the study. K-wires were crossing each other proximal to the fracture site in the proximal crossing group and at the fracture level in the fracture site crossing group. Loss of reduction, Baumann angle, shaft condyle angle, range of motion, and carrying angle were compared between the two groups. Results There were 43 males and 16 females in this study, with a mean age of 5.3±2.4 years. The average follow-up duration was 21.9 ± 5.2 weeks. In terms of loss of reduction in the coronal and sagittal planes, there was no statistical difference between the two groups. When the Baumann angle and shaft condylar angle of both groups were analyzed, no statistically significant differences were found at both early postoperative examination and final follow-up. Conclusions Although the crossing point of K-wires has been shown to be an important factor in the protection of reduction in biomechanical studies, it was not a significant factor for loss of reduction in this study. Factors except for the crossing point of K-wires may play a more important role in the outcomes of crossed-pin fixation.

Keywords: closed reduction; crossed-pin fixation; fracture line; gartland type 3 fractures; supracondylar humerus fracture.

Figure 1. Surgical technique.

(A) After reduction, K-wires measuring 2 mm for patients more than six years of age or 1.6 mm for patients six years old or younger were applied for fixation. (B and C) All medial pins were applied in the elbow at less than 80-degree flexion over a small incision centered on the medial epicondyle to prevent surgery-related ulnar nerve injury.

Figure 2. Grouping of patients with respect to the crossing point of K-wires.

(A) Crossing of the wire proximal to the fracture line. (B) Crossing of the wire at the fracture line.

Figure 3. Measurement of the range of motion and carrying angle of both extremities.

(A) The range of motion of both extremities of a patient in the study. (B) The carrying angle of both extremities of a patient in the study.