Lateral K-wires Research Articles

The Outcome of Placing the Medial K-wire First and Then the Lateral K-wire in Treating Supracondylar Humerus Fractures in Children Treated by Closed Reduction.

Background Displaced Gartland type III and IV supracondylar fractures are difficult to reduce and invariably require closed pining. After closed reduction, taking the anteroposterior (AP) view does not present any problem but when the elbow is placed in flexion and the limb is rotated internally to take a lateral view, the reduction is invariably lost. However, the reduction stays when the arm is rotated outwards, keeping the medial condyle up. This stimulates the idea of whether the medial pin can be placed first and then the two lateral pins to stabilize the fracture. It is very frustrating for young orthopedic surgeons to see reduction getting lost during internal rotation after first doing lateral pinning. There is no clear guideline on which side should be fixed first. Hypothesis We hypothesized that placing the medial pin first maintains the reduction and facilitates the subsequent placing of lateral pins without the loss of reduction. Materials and methods A total of 170 children with displaced supracondylar humerus fractures were included in the study. A total of 120 children were grouped in the medial wire first group, and 50 were placed in the lateral wire first group, which was the control group. The mean age of the children was 7.5 years (range 2-13 years). The gender ratio (M: F) was 5:3; the left elbow was involved in 68% of the injuries, whereas the right elbow was involved in 32% of the injuries. All 170 children had an extension-type injury, with 91 (53.5%) fractures being Gartland type III and 79 (46.45%) fractures being type IV. Results Results were recorded as per Flynn's criteria. At the end of two years of follow-up, the children in the medial wire first group 117 (97.5%) showed excellent resultsand three (2.5%) children showed good results, whereas, in the lateral wire first group, 48 (96%) children showed excellent results and two (3.8%) children showed good results. There was a significant difference in the mean surgical time of 20.11±15.43 minutes in the medial wire first group vs 41.23±19.65 minutes in the lateral first group (p = 0.0021). None of the children developed permanent ulnar nerve palsy. Conclusions Placing the medial K-wire first rather than the conventional placing of the lateral wire first helps in maintaining the reduction and allows for the subsequent placement of lateral K-wires without losing the reduction, thus minimizing fixation time and producing good results.

TO EVALUATE CLINICO-RADIOLOGICAL AND FUNCTIONAL OUTCOME OF EARLY MOBILIZATION AFTER CLOSE REDUCTION AND PERCUTANEOUS LATERAL K-WIRES FIXATION IN DISPLACED FRACTURE OF SUPRACONDYLAR HUMERUS IN CHILDREN

BACKGROUND: Supracondylar fracture is one of the commonest fracture in children account for 60% of all fractures around the elbow joint and represent approximately 3% of all fractures in children. ToAIM AND OBJECTIVES: evaluate clinico-radiological and functional outcome of early mobilization after closed reduction and percutaneous lateral k-wires xation in displaced fracture of Supracondylar humerus in children by using by Flynn's criteria. The present prospectiveMATERIAL AND METHODS: study was conducted on 34 patients from February 2020 to September 2021 who had displaced supracondylar humerus fracture. MeanResults: age of the study population was 6.8 years. A total of 20 were male patients and 14 were female. Majority of patients i.e. 26.4% got injuries due to fall from height. Maximum number of patients had type III Gartland fracture i.e. 20 followed by Type II i.e. 14 patients. Mean duration of trauma – surgery interval was 2.4 days. 50% of patients k-wire was removed at 3 weeks and rest 50% patients at 4 weeks. Final follow up at 6 months showed a total of 28 patients had loss of exion <5 degree followed by 6 patients who had loss of exion between 6-10 degree. Similarly, 31 patients had loss of extension<5 degree followed by 3 patients who had loss of extension 6-10 degree. After 6 months, we observed only 30 patients with <5 degree, 4 patients with 6-10 degree and none with >10 degree loss of carrying angle. In 2 patients, we found supercial pin site infection and in none of the patients we found any loss of reduction, delayed union, non-union, malunion and arthobrosis. A total of 28 patients had excellent results according to Flynn's criteria and 6 patients had good results. It is concluded that closed reduction andCONCLUSION: percutaneous lateral pinning is a sound and effective modality for the treatment of displaced supracondylar fractures of humerus.

A novel percutaneous intrafocal reduction technique for brachialis penetrating irreducible type 4 supracondylar humerus fracture

Type 4 supracondylar fractures are challenging to treat. Closed reduction may become impossible due to brachialis muscle penetration and devastating results like a neurovascular injury that may occur during recurrent manipulations. We here report an intra-focal percutaneous reduction technique for maintaining closed reduction. An extensively posterior displaced type 4 supracondylar fracture with a dimple at the antecubital fossa and an extensive ecchymosis is presented. During surgery, we could not obtain closed reduction with the milking maneuver. We inserted an intrafocal K-Wire from the posterior side into the fracture site. With the levering of the wire, the dimple disappeared, after which we maintained the anatomical reduction and fixed the fracture with two lateral K-wires. Neither complication nor residual deformity was observed during postoperative follow-up. To show the exact long-term effects and the safety of this procedure, we need more fractures with brachialis penetration operated on by the described technique.

Type III Supracondylar humeral fracture in children treated by 3 lateral versus 2 cross K-wire fixation, Aden, Yemen

Background: Supracondylar fractures of humerus are the most common elbow fractures seen in children. Objective: To describe the patients’ condition and to evaluate the treatment and the outcome. Materials and method: We retrospectively reviewed the records of 40 consecutive patients with 40 displaced, supracondylar fractures of the humerus treated between January 2019 and December 2020, in Aden. The obtained data were sex, age, side of injury, time between injury and fixation, trial of reduction and complications. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations; Fisher test was used and p-value < 0.05 was considered as statistically significant. The statistical software package SPSS version 17 was used. Results: The total study patients were 40 patients. Twenty-one (52.5%) were males and 19 (47.5%) were females. The age of the patients ranged between 2 to 10 years and the mean age was 6.6 ± 2.1 years. Twenty-four (60%) had the fracture on the right arm, and 16 (40%) had on the left arm. All the patients underwent surgery within 24 hours of injury. The mean time was 8.1 ± 4.5 hours. There were 11 (27.5%) cases of once trial reduction, 14 (35%) of twice trial reduction and 15 (37.5%) of three times trial reduction. The average removal of K-wires was 3.55 weeks. Twenty-six (65%) patients were treated by III lateral K-wires fixation and 14 (35%) were treated by crossed K-wire fixation. Post-operatively, (17.5%) patients got neuropraxia in the crossed K-wire group (n = 14), and none in the III lateral K-wire group. Two (5%) patients got angulation, one in the crossed K-wire group (n = 14), and one in the III lateral K-wire group (n = 26). Cupitus varus was seen in 2 (5%) patients in the crossed K-wire group and 2 (5%) in the III lateral K-wire group. Stiffness was found in the III lateral K-wire group with 2 (5%) patients. Conclusion: The delay in surgical treatment may cause a number of complications. Key words: Treatment, supracondylar fracture, humerus, children, Aden

Type III Supracondylar humeral fracture in children treated by 3 lateral versus 2 cross K-wire fixation, Aden, Yemen

Background: Supracondylar fractures of humerus are the most common elbow fractures seen in children. Objective: To describe the patients’ condition and to evaluate the treatment and the outcome. Materials and method: We retrospectively reviewed the records of 40 consecutive patients with 40 displaced, supracondylar fractures of the humerus treated between January 2019 and December 2020, in Aden. The obtained data were sex, age, side of injury, time between injury and fixation, trial of reduction and complications. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations, Fisher test was used and p-value < 0.05 was considered as statistically significant. The statistical software package SPSS version 17 was used. Results: The total study patients were 40 patients. Twenty-one (52.5%) were males and 19 (47.5%) were females. The age of the patients ranged between 2 to 10 years and the mean age was 6.6 ± 2.1 years. Twenty-four (60%) had the fracture on the right arm, and 16 (40%) had it on the left arm. All the patients underwent surgery within 24 hours of injury. The mean time was 8.1 ± 4.5 hours. There were 11 (27.5%) cases of once trial reduction, 14 (35%) of twice trial reduction and 15 (37.5%) of three times trial reduction. The average removal of K-wires was 3.55 weeks. Twenty-six (65%) patients were treated by III lateral K-wires fixation and 14 (35%) were treated by crossed K-wire fixation. Post-operatively, (17.5%) patients got neuropraxia in the crossed K-wire group (n = 14), and none in the III lateral K-wire group. Two (5.0%) patients got angulation, one in the crossed K-wire group (n = 14), and one in the III lateral K-wire group (n = 26). Cupitus varus were seen in 2 (5.0%) patients in the crossed K-wire group and 2 (5.0%) in the III lateral K-wire group. Stiffness was found in the III lateral K-wire group with 2 (5.0%) patients. Conclusion: The delay in surgical treatment may cause a number of complications. Key words: Treatment, supracondylar fracture, humerus, children, Aden

Radiation Exposure in The Treatment of Pediatric Supracondylar Humerus Fractures: Comparison of Two Fixation Methods

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.

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis.

Objectives This study aims to investigate the effects of the angles created by the Kirschner wires (K-wires), which are applied in the percutaneous fixation of supracondylar humerus fractures with cross K-wire, with the fracture line on fracture stabilization.Patients and methods The study was conducted on distal humerus fracture models. Medial and lateral K-wires were placed in the fracture models. The angle between the fracture line and the K-wire inserted from medial was represented by alpha (α), while the angle between the fracture line and the K-wires inserted from lateral was represented by beta (β). A combination of various angles (30°, 45°, and 60°) was used in each model, where no two models had the same combination of α and β, resulting in nine different wire configurations. The simulation program was used to simulate the effects of forces, which were applied on rotation, flexion and extension directions, on these models. We measured and compared the stress on the wires and the displacement of fractures under different force configurations.Results When the force was applied in the counterclockwise direction, the stresses were 58 megaPascal (MPa) on medial K-wire, 24 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. When the force was applied in the clockwise direction, the stresses were 57 MPa on medial K-wire, 23 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. In all models, the increased α and β angles were translated into the decreased stress on K-wires at the fracture level and decreased displacement under rotational deforming forces. Despite having generally lower fracture displacement, the increased α and β angles led to variable changes in the stress on K-wires against flexion and extension forces.Conclusion In supracondylar humerus fractures, increasing the insertion angle of both medial and lateral K-wires augments stabilization and reduces displacement, particularly against rotational deforming forces.

A prospective study of malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy

Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy Supracondylar humeral fractures are most common elbow fractures in children. The most common complication among all is malunion leading to cubitus varus deformity.Lateral closing wedge osteotomy is the easiest, the safest, and inherently the most stable osteotomy to correct the varus deformity with minimal correction of hyperextension. Aim: To examine the malunited supracondylar fracture of humerus in children treated with lateral closed wedge (LCW) osteotomy with cubitus varus. Material and Methods: A total of 25 children of malunited supracondylar fracture of humerus were treated by lateral closed wedge osteotomy fixed by two screws and figure of eight tension band wire.The fixation was supplemented with one lateral K-wire. Post-operatively, according to Oppenheim’s criteria patient were evaluated and parents and patient’s satisfaction with final appearance and function of the limb was taken into consideration. Results: According to the Oppenheim et al. criteria, is similar to our study, excellent outcome was noted in 18(72%) cases, good outcome in 5(20%) cases and poor outcome in 2(8%) cases. 18(92%) patients/parentswere satisfied with the final outcome. Conclusion: Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity with less complications.

Comparison of closed reduction and percutaneous cross verses parallel k wire fixation in supracondylar fractures of the humerus in children.

Around the elbow, supracondylar injury of humerus is one of the conventional fractures which usually occurs at the age of 7 to 8 years. Various conservative techniques have been used for the management, which comprises of the splintage, tractions, open or closed reduction with k wire fixation. However, closed reduction and percutaneous pinning remains the mainstay of surgical management, for they have shown splendid outcomes according to many authors. Objectives: The aim of this study is to summarise and compare the radiological and functional results of two ways of fixation (cross and parallel closed K wires) of supracondylar fractures in children. Study Design: Randomized controlled trial. Setting: Department of Orthopaedics Surgery, Services Hospital, Lahore. Period: 1st January 2018 to 31st June 2018. Material & Methods: We included 180 patients (90 in each group). Results: The mean age was 6.45±2.34 years with 115(63.9%) male and 65(36.1%) female. Among the children who underwent fixation with cross k-wires, ulnar nerve injury was seen in 2(2.2%) cases and none were seen in the other group post operatively. Group A attained higher union rate at last follow up. 4(4.4%) cases in Cross K-wires and 19(21.1%) in two lateral k-wires gave outstanding outcome. In a nutshell, 60 in group A and 45 in group B showed excellent outcomes based on Flynn's criteria, p-value < 0.05. Conclusion: According to Flynn’s criteria, closed percutaneous cross K-wire fixation of supracondylar fracture of humerus is an effective management option in terms of finer functional results as compared to Parallel k-wires. Although, the rate of radiological union is higher in cross k-wire fixation, there are 2.2% chances of ulnar nerve injury.

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

BackgroundManagement of distal humerus metaphyseal-diaphyseal junction (MDJ) region fractures can be very challenging mainly because of the higher location and characteristics of the fracture lines. Loss of reduction is relatively higher in MDJ fractures treated with classical supracondylar humerus fractures (SHFs) fixation techniques.MethodsThree different fracture patterns including transverse, medial oblique and lateral oblique fractures were computationally simulated in the coronal plane in the distal MDJ region of a pediatric humerus and fixated with Kirschner Wires (K-wires), elastic stable intramedullary nails (ESIN), and lateral external fixation system (EF). Stiffness values in flexion, extension, valgus, varus, internal, and external rotations for each fixation technique were calculated.ResultsIn the transverse fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion, varus, internal, and external rotations, while 3L (3-divergent lateral K-wires) was the most stable in extension and valgus. In the medial oblique fracture model, EF had the best stiffness in flexion, extension, valgus, and varus loadings, while the best stiffness in internal and external rotations was generated by 3MC (2-medial, 1-lateral K-wires). In the lateral oblique fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion and internal and external rotations, while ESIN had the best stiffness in extension and valgus and varus loadings.ConclusionThe best stability against translational forces in lateral oblique, medial oblique, and transverse MDJ fractures would be provided by ESIN, EF, and K-wires, respectively. K-wires are however superior to both ESIN and EF in stabilizing all three fracture types against torsional forces, with both 2-crossed and 3-crossed K-wires having comparable stability. Depending on the fracture pattern, a 3-crossed configuration with either 2-divergent lateral and 1-medial K-wires or 2-medial and 1-lateral K-wires may offer the best stability.

Surgical Management of Paediatric Neglected Humeral Supracondylar Fracture: A Series of 3 Cases in 3 Years

Introduction: Supracondylar fracture of the humerus is common among paediatric population. In our country, it is not uncommon for patients to present late to the hospital after an injury. Devnani reported a case series of 28 children who sustained supracondylar humerus fracture and presented late (mean 5.6 days) to the hospital. We report our experience in managing 3 patients who presented late (range 15 days to 8 months) with neglected supracondylar humerus fracture in 3 years. Case report: Case 1: A right hand-dominant 5-year-old boy sustained a fall 8 months prior to presentation to the hospital. He was treated with traditional methods immediately after the injury. He presented with malunion of left humeral supracondylar fracture with varus deformity and limited left elbow range of movements. An open reduction (lateral approach) and corrective osteotomy were performed and 2 lateral K-wires were inserted. Case 2: A 10-year-old boy with right hand dominance sustained a closed left supracondylar humerus fracture Gartland 3 after a fall. His parents initially refused any surgical intervention. However, they finally agreed for surgery on day 15 post-trauma. An open reduction (posterior approach) and callus removal were done and 2 crossed K-wires were inserted. Case 3: A right hand-dominant 5year-old girl had history of fall 1 month prior to presentation to the hospital. She was treated with traditional methods initially. She presented with malunion of the left supracondylar humerus fracture with limited range of motion of her left elbow. An open reduction (posterior approach) and corrective osteotomy were performed and 2 crossed K-wires were inserted. Discusssion: Two patients underwent open reduction via the posterior approach and 1 patient via the lateral approach. Only one patient required callus removal while 2 patients required osteoclasis. All patients recovered without complication and there was improved range of movement of the elbows. Conclusion: Surgical intervention is the treatment of choice in managing neglected supracondylar humerus fracture.

Functional outcome in surgical management of supracondylar fracture of humerus in children

Background: Supracondylar fracture of humerus is an extra-articular fracture occurring in the distal metaphyseal region of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Surgical treatment is reserved only for a failed closed reduction, fractures with neurovascular injuries and open fractures. These fractures need a precise treatment approach in order to obtain satisfactory result and to avoid complications. The purpose of our study is to determine the functional outcome of the surgical management of displaced Supracondylar fracture of humerus.Methods: This is a prospective study among 30 patients of age group 5-12 years diagnosed with displaced Supracondylar fracture of Humerus who were operated during the period from December 2017- March 2019.All of them underwent Closed/Open reduction internal fixation with medial and lateral K-wires fixation followed by early mobilization of elbow. Follow up was done on OPD basis 6 month post operatively. Clinical and radiological assessment was done and Flynn’s criteria was used to evaluate the final results.Results: Out of 30 patients, 23 were males and 7 were females. The age distribution in our study was 3 to 15 years. Maximum patients in our study were from 5-12 years of age group. The mean age of the patients was 7.97 years.22 had injury over Left elbow and 8 had injury over Right elbow. According to Flynn’s criteria, 24 patients (80 %) had excellent result, 5 (16.67%) had Good result and 1 (3.33%) had fair result. None had poor outcome.Conclusion: We can conclude that closed/open reduction with cross k-wires fixation is an excellent modality of treatment and surgery of choice in partially and completely displaced Supracondylar fracture of Humerus.

Tuber-to-Anterior Process Angle (TAPA): A Cadaveric Study and Surgical Technique for Placing Axial Calcaneal Screws

Category:Ankle, HindfootIntroduction/Purpose:Operative management of displaced intra-articular calcaneus fractures frequently involves placement of P: A screws in order to maintain calcaneal length and axial alignment. While plate fixation may still be more commonly utilized, screw-only fixation for the treatment of these fractures has been demonstrated by several authors to be safe and effective.Directing fixation from the tuber into the anterior process can be challenging. Understanding the calcaneal long-axis as it relates to the long-axis of the foot, a measurement we call the Tuber-to-Anterior Process Angle (TAPA), can facilitate the ease and accuracy of guide-wire and cannulated screw placement.The goals of this study are to define the TAPA, and to report a surgical technique which uses this angle to facilitate axial screw placement.Methods:Eight cadaver feet were utilized. A longitudinal pin was placed from the center of the posterior calcaneal tuber to the 2nd metatarsal heads. Next, the calcaneocuboid joint was exposed, and a wedge of cuboid was removed. A calcaneal pin was then placed, exiting at the center of the anterior process. The tips of two small K-wires were impacted into the medial and lateral-most aspects of the articular surface. A true axial view of each specimen was obtained. On these images, a digital line was drawn from the posterior tuber starting point and the central calcaneal pin, representing the calcaneal long-axis. The angle subtended by this line and the long-axis of the foot represents the TAPA. Digital lines were drawn between the posterior tuber starting point and the medial and lateral K-wires, and the range between their subtending angles represents the axial plane tolerance for screw placement within the anterior process.Results:The average TAPA measured 10.9 ± 1.3 degrees (range: 8.4-13.0). The average angle, as measured to the medial extent of the anterior calcaneus, measured 2.8 ± 1.3 degrees (range: 0.4-4.3). The average angle, as measured to the lateral extent of the anterior calcaneus, measured 19.0 ± 2.7 degrees (range: 15.7-22.7).Conclusion:Knowledge of the Tuber-to-Anterior Process Angle (TAPA), found to be 10.9 degrees (± 1.8 degrees) laterally deviated from the long-axis of the foot, simplifies placement of posterior-to-anterior screws in the calcaneus. Understanding this relationship reduces reliance on intraoperative axial fluoroscopy and increases operative efficiency. Furthermore, this knowledge can be applied during other procedures in which axial screw placement is performed, such as with corrective calcaneal osteotomy.

Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Background:
 Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability.
 Materials and Methods:
 This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture.
 Result:
 Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups.
 Conclusion:
 Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

Evaluation of management of malunited supracondylar fracture of humerus by lateral closing wedge osteotomy

<p class="abstract"><strong>Background:</strong> Various osteotomies have been in use for correction of varus deformity at elbow secondary to malunited supracondylar humerus fracture in children. The objectives of the study were to determine the efficacy & outcome of lateral closing wedge osteotomy in children as a treatment of malunited supracondylar fracture of humerus with cubitus varus and to evaluate various technical problems, morbidity, complications of Lateral closing wedge osteotomy and to suggest ways to overcome them.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted among 50 cases of malunited supracondylar fracture of humerus who visited in OPD during 1st September 2008 to 31st August 2010. After pre-operative assessment, lateral closing wedge osteotomy was done and fixed with two 3.5 mm screws, figure of eight tension band stainless steel wire and a supplemental lateral k-wire. Post operatively x-ray of patient was taken and carrying angle and range of movement were calculated. Patients were re-assessed at complete union.<strong></strong></p><p class="abstract"><strong>Results:</strong> Maximum patients were from the age group of 8 to 10 years- 22 cases, mean age 13.08 years, 80% male. Left (non-dominant) side was involved in 30 (60%) cases. Around 18% cases developed complications. 25 (50%) patients had no loss of range of movement and 2 (4%) had 16 to 20 degrees loss of range of movement. Almost 36 (72%) cases had excellent outcome, 11 (22%) cases had good outcome, 3 (6%) cases had poor outcome due to loss of fixation, 47 (94%) patients/parents were satisfied with the final outcome.</p><p class="abstract"><strong>Conclusions:</strong> Lateral closing wedge osteotomy with a lateral K-wire is a sound, cost-effective, technically less demanding modality of treatment for varus deformity due to malunited supracondylar fracture of humerus in children with minimum complications.</p>

Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration.

Background:Supracondylar humerus fracture is the most common fracture around elbow in children. Closed reduction and percutaneous Kirschner wire (pin) fixation is the standard method of managing displaced extension type (Gartland Type II and Type III) supracondylar humerus fractures. The configuration of wires is debatable. Although two crossed K-wires are mechanically stable, there is an inherent risk of ulnar nerve injury. Lateral K-wires – parallel or divergent – are good alternative. This study was aimed at identifying the best configuration for the lateral wires.Materials and Methods:Patients with Gartland type 3 supracondylar humerus fractures were randomized by envelope method to receive closed reduction and K-wire fixation in either a parallel or divergent fashion. The patients were followed up at 3 weeks for wire removal and at 6 weeks and 3 months after surgery. Baumann's angle, functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Effect of delay in surgery was also evaluated as a secondary outcome.Results:Nineteen patients received fixation with parallel wires and 11 patients had divergent fixation. No loss of reduction was seen in any patient at 3 months. No statistically significant difference was seen in the Baumann's angles and outcome according to Flynn's criteria irrespective of the wire configuration (divergent or parallel). Furthermore, the delay in surgery was also found not to have a significant effect on the functional outcome.Conclusions:Both parallel and divergent K-wire configurations provide satisfactory stability when accurate reduction and adequate fixation of the fracture has been done. Based on the limited number of patients in this study, one configuration cannot be judged to be superior to the other.

Biomechanical analysis between Orthofix\xae external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

BackgroundClosed reduction and percutaneous fixation are considered as the optional treatments for displaced supracondylar humerus fractures. However, there was no published report about the biomechanical analysis in Orthofix® external fixator. In this study, we developed a model of supracondylar humerus fractures and compared the biomechanical analysis of external fixator and different K-wires configurations in order to evaluate the stability of external fixator in supracondylar humerus fractures.MethodsWe developed an anatomic humerus model by third-generation synthetic composite, and 60 synthetic humeris were osteotomized to simulate the humeral transverse supracondylar fracture. Those fractures were reduced and fixed by external fixator or K-wires, and then biomechanical analysis was performed in extension, varus, valgus, and internal and external rotation loading. A paired-sample t test was used to evaluate the distance at the fracture site between the external fixator and K-wire configurations.ResultsDuring all direction loading, there was a significant statistical difference between external fixator and K-wires (P < 0.001 for all pairwise comparisons). In extension and internal rotation loading, the external fixator and three crossed K-wires had no comparable stiffness values (P = 0.572; P = 0.795), and both were significantly greater than two crossed and lateral K-wires (P < 0.05). In external rotation loading, there was no significance between the external fixator and K-wire configurations except two lateral K-wires (P > 0.05). In valgus loading, the stability of the external fixator was less than that of three crossed K-wires (P = 0.001) but was not significantly different with those of two crossed or three lateral K-wires (P = 0.126; P = 0.564). In varus loading, the stability of the external fixator was larger than those of two and three lateral K-wires (P = 0.000; P = 007).ConclusionsExternal fixator could provide enough stability for pediatric supracondylar humerus fractures without the injury of the ulnar nerve. Besides, it could enhance the rotational stiffness of the construct in rotation loading to avoid the complication of cubitus varus.

To compare the functional outcome of cross k-wires v/s lateral k-wires in Gartland type-III supracondylar humerus fracture in paediatric age groups

Introduction: Supracondylar fractures of the humerus are very common fractures in pediatric age groups. If displaced, preferred treatment is close reduction with percutaneous K-wire fixation. This study compares the functional outcome of cross k-wires v/s lateral k-wires in Gartland type III supracondylar humerus fractures in paediatric age groups. Materials and Methods: 30 cases of supracondylar fractures of the humerus gartland type III in children operated with closed reduction and pinning of which 15 were of lateral and 15 were of cross k wires group from January 2015 to June 2017 with minimum 4 months follow-up period were consideredResults: Functional outcome of the patients was assessed by Flynn’s criteria. Results were excellent 13.33%, good 40% fair 46.6% in cross k wire group and excellent 6.6%, good 46.6% fair 40% and poor 6.6% in lateral k wire groupConclusion: Both lateral entry pin fixation and crossed pin fixation are effective in the treatment of gartland type III extension supracondylar fractures of the humerus in children.

Study of Supracondylar Fracture of Distal Humerus in Children and Its Management with Lateral K-Wire Fixation

Background: Supracondylar fracture is one of the common fractures in children. There are different methods of treatment. This study was undertaken to evaluate the results of lateral k wire fixation for the displaced supracondylar fracture of distal humerus in children. Methods: There were 32 children with displaced Supracondylar fracture, treated with closed reduction and percutaneous lateral K-wires fixation. Clinical and radiological assessments were done and outcomes were assessed on basis of Flynn criteria and data were analyzed in SPSS 16. P value &lt;0.05 was considered significant. Result: The mean age of patients was 6.41 ± 2.37 with boys predominant. There were excellent result of 24(75%) good result 5(15%) regarding carrying angle and regarding range of motion 25 (78%) excellent and4(12%) good result. There were more than 90% patients with excellent to good result. Comparing the Baumann’s angle intra-operatively and at the final follow up, there was no statistically significant difference with P value &gt; 0.05. Conclusion: Lateral pinning with 2 and if necessary 3 k wires for proper stabilization and idea configuration of divergent to hold medial and lateral column is the ideal treatment of supracondylar fracture without risk of iatrogenic nerve injury. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 38-43 DOI: http://dx.doi.org/10.3126/njms.v3i1.10356

Lateral entry fixation using three divergent pins for displaced paediatric supracondylar humeral fractures.

Background. Supracondylar fractures are the commonest elbow injury in children. Most displaced supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. This clinical study has results purely from a three lateral divergent wire technique. Methods. Displaced supracondylar fractures were manipulated closed and three lateral divergent wires inserted. Primary study end points were range of movement and carrying angle relative to the contralateral uninjured elbow (Flynn's grading system) and presence of iatrogenic nerve or vessel injury. Results. 25 children between 3 and 10 years (median 5, range 3–10) suffered a displaced fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21 in the first 24 hours. 2 were delayed due to swelling. 2 were fixed secondarily with lateral k-wires after loss of position (from a primarily fixed crossed wire technique). One radial and one median nerve palsy sustained at injury settled. No iatrogenic nerve injuries occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading. Conclusions. The use of three wires on the lateral side in this cohort showed no evidence of slip in fracture position and no iatrogenic nerve injury.