Clinical application of Kirschner wire for assisting closed reduction of pediatric humeral shaft fracture with elastic intramedullary nailing

Abstract

Objective To employ Kirschner wire for assisting closed reduction of pediatric humeral shaft fracture with elastic intramedullary nailing and compare its efficacy with that of manual reduction. Methods From February 2010 to August 2013, 41 cases of pediatric humeral shaft fracture underwent closed reduction and elastic intramedullary nailing. Kirschner wire was used for closed reduction and fixation with elastic intramedullary nailing (group A, n=20) while manual method for closed reduction and fixation with elastic intramedullary nailing (group B, n=21). There were 11 males and 9 females with a mean age of 8.82±3.12 years in group A versus 13 males and 8 females with a mean age of 9.09±2.78 years in group B. And the success rates of closed reduction, operative duration, frequency of radiation, complications, fracture union time, hospitalization time and function score were compared. Results All cases underwent successful closed reduction in group A. For group B, closed reduction was successful in 16 cases and another 5 cases underwent open reduction. Significant inter-group difference existed in success rate of closed reduction (P<0.05). Operative duration was 35.5±4.60 min and irradiation times 10.21±3.53 in group A versus 47.5±7.00 min and 14.70±5.02 in group B. And significant inter-group differences existed in operative duration and irradiation time(P<0.001, P=0.003). For group A, fracture union time was 7.32±1.03 weeks and hospitalization time 6.54±1.21 days. And the fracture union time of group A was 7.64±0.88 weeks and hospitalization time 6.94±1.53 days. No significant inter-group difference existed in fracture union time or hospitalization time(P=0.331, P=0.387). Radial nerve injury (n=2) and wound infection (n=1) occurred in group B while group A had no complication. No significant inter-group difference existed in complications(P=0.106). The function scores of two groups were 91.2±3.1 and 90.1±5.1 respectively. And inter-group difference was statistically insignificant (P=0.430). Conclusions Comparing with manual reduction, using Kirschner wire for assisting closed reduction of pediatric humeral shaft fracture with elastic intramedullary nailing can improve the success rate, significantly shorten operative duration and reduce radiation exposure. Yet there is no impact upon clinical efficacies. Key words: Fracture of humeral shaft; Closed reduction; Kirschner wire