Surgical management of unstable supracondylar fractures of humerus in children by closed reduction and percutaneous k wire fixation by crossed versus triple pin configuration: A comparative study

Abstract

Background: Supracondylar fracture of humerus in children is one of the most common fractures seen in pediatric orthopedic clinic setting worldwide. Closed reduction and percutaneous K wire fixation is preferred method of treatment and should be attempted at earliest possible time. In this study, displaced extension type supracondylar fractures in children were managed with closed reduction and percutaneous K wire fixation using image intensifier so as to study age, sex incidence and side preponderance, assess clinical and radiological outcomes. To compare clinical outcomes in two types of pin configurations (crossed and triple) and early and late complications associated with these procedures. Materials and methods: This study was conducted between June 2013 and June 2015 in the Department of Orthopaedics in Karnataka Institute of Medical Sciences, Hubballi. The mean age of the patients was 8.73 years (range 6–13 years). The male/female ratio was 3:1 and left side was involved in 53.8 % whereas 42.2% had right sided injuries. All the 26 admitted patients had extension type injury with 96.15% fractures being Gartland type III and 3.85 % were type II. Posteromedial displacement was noted in 57.7 % whereas 42.3 % fractures were posterolaterally displaced. In 13 cases, crossed K wires were used whereas, in 13 cases, two lateral and one medial K wire was used. K wires were removed at 4 weeks postoperatively and follow-up was done at 8, 12 weeks and final follow-up at 6 months when they were evaluated according to the criteria described by Flynn. Chi square test and Fischer –Exact test was used as a statistical tools to compare results among different variables. Results: All 26 patients had satisfactory outcomes (100%) as per Flynn’s criteria. Although Triple pinning has shown better results but there was no statistical difference in the final outcomes and complication rates in patients treated by either crossed or triple pinning technique due to small sample size. Younger age patients were found to have better final clinical outcomes to older children. Patients who had Baumann angle within 4 degrees compared to normal side had better final outcomes and it can used as a reliable radiologic parameter to assess adequacy of reduction. Conclusion: Closed reduction and percutaneous fixation using K wires gives excellent results and is the most accepted modality for treating displaced supracondylar fractures of humerus in children. Triple pinning has shown encouraging results in comparison to Crossed pinning, but larger sample size is needed to give statistical significance to the comparative study.