Abstract
Aim: The study aims to determine the estimated radiation exposure of two different types of fixation (crossed vs lateral-entry K-wires) for displaced supracondylar fractures at a Major Trauma Centre in London. Methods: A retrospective review was performed between 2015 and 2019 in children (<16 years old) who underwent either Closed Reduction and Percutaneous Pinning (CRPP) or open reduction and K wire fixation for a displaced supracondylar fracture (Gartland II, III and IV) of the humerus. Results: The overall mean radiation dose and duration with crossed K-wire fixation was statistically lower when compared with two lateral K-wires. The mean radiation dose increased with increasing Gartland Grade - for Gartland Grades II, III and IV respectively. Conclusion: The current study showed statistically significant decreased radiation dose in crossed K-wire fixation method, compared to lateral-entry fixation. No difference was found regarding the cosmetic/functional outcome when Flynn’s criteria were applied.
Highlights
Supracondylar fractures are the most common elbow fractures in children, with the prevalence from 3% to 18% of all pediatric fractures [1, 2]
The overall mean radiation dose and duration with crossed K-wire fixation was statistically lower when compared with two lateral K-wires
The mean radiation dose increased with increasing Gartland Grade - for Gartland Grades II, III and IV respectively
Summary
Supracondylar fractures are the most common elbow fractures in children, with the prevalence from 3% to 18% of all pediatric fractures [1, 2]. A variety of pinning configurations has been described, with crossed and lateral-entry K-wire configurations being the two most common. Calculating the radiation dose to a patient is complex (patient size, thickness of body/body composition in the plane of beam and energy of beam) [3]. Children have greater radiosensitivity than adults, and the mortality risk from cancer after radiation has been estimated at 5% per Sievert for adults and up to 9% for a 10year old child, with the risk increasing for younger patients [5]. Minimizing radiation during paediatric orthopaedic procedures like supracondylar fixation is crucial
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