K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures

Abstract

Objective To evaluate K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures of Gartland types Ⅱ&Ⅲ. Methods From June 2014 to March 2016, 31 children with irreducible supracondylar humeral fracture were treated operatively in our hospital. They were 23 boys and 8 girls, aged from 4 to 11 years (average, 6.3 years), involving 19 left and 12 right arms. Their clinical manifestations included elbow swelling at the affected arm, obvious tenderness, and limited movement of the elbow. The reduction was conducted under the guidance of C-arm roentgenography by inserting a piece of 3.0 mm K-wire into the fracture ends via the posterior triceps tendon, inserting 2 pieces of 1.5 or 2.0 mm K-wire from the distal lateral humerus to the proximal through the opposite cortical bone, and inserting a piece of 1.5 or 2.0 mm K-wire into the opposite cortical bone through the ulnar aspect of the distal humerus. Results The operation time for the 31 patients ranged from 28 to 42 minutes (33 minutes on average). They were followed up for 6 to 18 months (12.3 months on average). All fractures united after 4 to 6 weeks (4.6 weeks on average). At the final follow-ups, the lengths of the affected and healthy arms were respectively 66.4±2.7 cm and 66.4±2.9 cm, showing no significant difference (P>0.05). The therapeutic outcomes by the Flynn criteria for the elbow function were rated at the final follow-up as excellent in 26 cases, as good in 4 and as fair in one, yielding an excellent to good rate of 96.8%. Pin tract infection occurred in 2 patients, but no deep infection or osteomyelitis was observed during follow-ups. Conclusion K-wire leverage reduction and fixation via the triceps is an effective and simple treatment for irreducible supracondylar humeral fractures of Gartland types Ⅱ&Ⅲ. Key words: Humeral fractures; Fracture fixation, internal; Kirschner wire; Children