Closed Reductions and Percutaneus ‘K’ Wire Fixation for Adolescent Intercondylar Fractures of the Distal Humerus

Abstract

Intercondylar (T-Condylar) fractures of the humerus are very rare in children. The usual mechanism of the injury which is involved is a fall on a flexed elbow. The treatment options vary, depending upon the degree of the displacement and the amount of comminution and; they may range from a simple application of traction to open reduction and internal fixation with plates and screws. Open reduction is associated with significant post-operative stiffness of the elbow and subsequent less than satisfactory functional results. In this publication, we are presenting our experience of treating seven adolescent T-Condylar fractures of the distal humerus with closed reductions and internal fixations with the percutaneus Kirchner ('K') wire. Seven patients (M:F-6:1) with an average age of 14(range 12-16) years were treated by closed reduction and internal fixation with a 2.0 mm 'K' wire fixation under an image intensifier. Following the surgery, all the elbows were immobilised in plaster of Paris (POP) splints for three weeks. At three weeks after the surgery, the pop splints were removed and gentle elbow exercises were started. Five weeks after the surgery, the 'K' wires were removed, based on the radiological evidence of a bridging callus formation. Six patients (85%) out of seven showed satisfactory functional results on the Mayo Elbow Performance Score (MEPS), with a good range of motion at the elbow joint. Three (42%) patients had mild elbow stiffness, which resolved on subsequent treatment, while one (14%) had a mild pin tract infection, who was managed conservatively. There was one patient (14%) who was lost to follow-up, who ultimately had a painful and a stiff elbow. The remaining six patients were able to return to the premorbid sate. We recommend closed reduction and percutaneous 'K' wire fixation for adolescent T- Condylar fractures of the humerus as an easy and inexpensive procedure with satisfactory functional results.