The safety of humeroradial fixation using Kirschner wires in children

Abstract

Humeroradial joint fixation (HJF) has been employed during elbow surgery to maintain stability. Kirschner wire (K-wire) fixation is the most commonly used method in children; however, there are valid concerns regarding complications such as breakage. In this study, we retrospectively analyzed the safety of humeroradial fixation using K-wires in children. In total, 249 patients diagnosed with Monteggia fractures underwent HJF at our institute from January 2013 to November 2021. All relevant clinical data were collected after applying the inclusion and exclusion criteria. Skin irritation, incision infection, elbow instability, and ulnar healing were followed up. The elbow function was evaluated using Mackay standards. There were 81 females and 168 males (average age, 6.6 ± 2.8 years). Of these patients, 67 did not have ulna fixation, whereas 127 were fixed with K-wires after osteotomy of the proximal ulna or correction of the deformity. The K-wire sizes used for HJF were 1.6, 1.8, and 2 mm in 6, 125, and 118 patients, respectively. The duration of K-wire fixation of the humeroradial joint was 6.6 ± 2.5 weeks on average. Two patients suffered from K-wire breakage and underwent reoperation. There were three patients with K-wire end irritation. According to Mackay standards, the elbow function score was excellent, good, and poor in 188, 41, and 20 patients, respectively, at 6 months postoperatively. No bone bridge was found at the capitellum and radial head fixation sites in any patient. HJF using K-wires combined with a cast is a safe method with a low incidence of complications in children and should be considered a reliable option when humeroradial joint fixation is required. LEVEL OF EVIDENCE: IV.

Keywords: Children; Elbow injury; Humeroradial joint fixation; Kirschner wire; Mackay standards.

Fig. 1

Different fixation materials for the treatment of Monteggia fractures. All humeroradial joints were fixed using a Kirschner wire (K-wire, red arrow). (a) Ulnar fixation using a steel plate (green arrow). (b) Ulnar fixation using a K-wire. (c) Ulnar fixation using an external fixation system.

Fig. 2

An eight-year-old boy with an old right elbow Monteggia fracture. (a) Radiograph of the old Monteggia fracture before surgery. (b) Humeroradial joint fixation using a Kirschner wire (K-wire; green arrow) combined with a posterior and anterior plaster cast postoperatively. (c) Break in the K-wire (green arrow) 35 days postoperatively. (d) K-wire was kept in the radius.

Fig. 3

Nine-year-old boy with a right Monteggia fracture. (a) The fracture was reduced, and the supracondylar humerus fracture was fixed by a Kirschner wire (K-wire) applied to the humeroradial joint (green arrow), (b) Broken K-wire at 22 days postoperatively. (c) Partial removal of the broken K-wire (green arrow). (d) Partial K-wire in the proximal radius. (e) The K-wire was removed by opening the radial window.