The Functional Outcome of Closed Reduction Percutaneous K-Wire Fixation of Type 3 Supracondylar Humerus Fractures

Abstract

Background: Supracondylar fractures of the humerus are among the most common pediatric fractures, accounting for a significant portion of elbow injuries in children. The management of these fractures, especially Type III fractures which are completely displaced, poses a challenge due to the potential for serious complications and difficulties in achieving satisfactory reduction. The current standard treatment involves closed reduction and percutaneous pinning under fluoroscopic guidance. However, delays in presentation and treatment can complicate outcomes, particularly in resource-limited settings. Objective: The objective of this study was to evaluate the safety and effectiveness of closed reduction and percutaneous K-wire fixation in children presenting with Type III supracondylar humerus fractures after a delay. Methods: This descriptive case series was conducted at Lady Reading Hospital MTI, Peshawar, from February 2023 to February 2024. A total of 84 patients aged 3-10 years with Type III supracondylar humerus fractures were included. Patients with neurovascular complications at presentation, other types of fractures, or those with multiple traumas were excluded. The study utilized non-probability, consecutive sampling. Procedures were performed under general anesthesia with fluoroscopic guidance, and outcomes were assessed using Flynn's criteria. Data analysis was conducted using SPSS version 25. Results: Of the 84 patients, 45.2% were male and 54.8% were female. The age distribution was 36.9% for ages 3-5 years, 38.1% for ages 6-7 years, and 25% for ages 8-10 years. Closed reduction and percutaneous pinning were successful in 90% of the cases, with only 10% requiring conversion to open reduction. Flynn's criteria indicated that 31 patients (36.9%) achieved excellent outcomes, 23 (27.4%) good, 10 (11.9%) fair, and 20 (23.8%) poor. The rate of pin tract infection was 7.5%. Conclusion: The study concludes that closed reduction and percutaneous pinning is a safe and effective method for treating children with delayed presentation of Type III supracondylar humerus fractures. Despite the delay in treatment, the majority of patients achieved favorable functional outcomes with a low incidence of complications.