Determination of lateral needle insertion point in percutaneous Kirschner wire fixation for pediatric supracondylar fractures of humerus

Abstract

Objective To report our method to determine lateral needle insertion point(intersection point skin marker)in closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus. Methods From May 2012 to June 2014, 125 children with supracondylar fracture of humerus were treated with closed reduction and percutaneous Kirschner wire fixation. Of them, 60 did not use the intersection point method to determine the lateral needle insertion point(group A), including 46 boys and 14 girls, with an average age of 6. 3 ± 0. 6 years. According to Gartland classification, 28 cases were type Ⅱ and 32 cases type Ⅲ. In the other 65 children, the intersection point method was used to determine the lateral needle insertion point(group B), including 50 boys and 15 girls, with an average age of 6. 4 ±0. 9 years. According to Gartland classification, 29 cases were type II and 36 cases type Ⅲ. The 2 groups were compared in terms of operation time, fluoroscopy times, hospital stay and hospitalization cost. The efficacy was evaluated at the final follow-ups using Flynn criteria. The 2 groups were compatible without significant differences in preoperative general data(P> 0. 05). Results All the 125 children obtained successful closed reduction and percutaneous pin fixation, and an average follow-up of 13 months(from 12 to 15 months)as well. There were significant differences between groups A and B in average operation time(23. 1 ±15. 3 min versus 17. 5 ±10. 3 min)and fluoroscopy times(9. 2 ±1. 0 times versus 5. 3 ±1. 3 times)(P 0. 05). Needle irritation occurred in 2 cases and Kirschner wire shift in one in group A while tensile blistering occurred in one in group B. Conclusion In closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus, the intersection point skin marker is a simple and reliable method to determine the lateral needle insertion point, leading to considerable reduction in radiographic exposure for both patients and doctors. Key words: Humeral fractures; Surgical procedures, minimally invasive; Fracture fixation, internal