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The outcome of displaced pediatric supracondylar fractures of the elbow treated with lateral three divergent K wires


MOJ Orthopedics & Rheumatology
Shiva Chandra Amatya,1 Subin Byanjankar,2 Rishi Bisht3

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Abstract

1.1.  Introduction: Supracondylar fracture of the humerus is the commonest elbow injury in children, treated with closed reduction and percutaneous fixation. Crossed K-wires fixation is more biomechanically stable than lateral K – wires only. Recent biomechanical studies have shown that 3 lateral divergent K—wire fixation is as stable as cross K-wire fixation.Furthermore, lateral divergent fixation is associated with a good clinical outcome.

1.2.Methods:A descriptive cross-sectional study was conducted in the department of orthopedics at People’s General Hospital, Kathmandu between the period of January 2018 to December 2020. Medical records of 76 supracondylar fractures of humerus Gartland type III and IV were reviewed out of which 46 patients were included in the study after meeting the inclusion criteria.Radiological assessment was done to assess fracture union and stability. Flynn's grading system was used for functional outcomes.

1.3.  Results:The mean age was 7.3 years (range 4 – 13 years). The boys were 32 (70%) and girls were 14 (30%). The follow-up was 9.2 months (range 3 – 12 months). At the final follow-up, the mean range of elbow motion at final follow up was 0.86 ± 4.58° - 135.86 ± 4.078°, the mean arc of motion was 139.9 ± 6.2°, and the mean carrying angle was 13.63± 32.15°. No iatrogenic ulnar nerve injury was noted. Five patients (10.8%) had superficial pin site infection, managed with local dressings after pin removal. According to Flynn’s grading system, 41 patients (89.1%) achieved excellent results, and one patient had poor results. None of them had chronic discharge after the wire removal.

Conclusion:Closed reduction and percutaneous 3 lateral divergent K – wire fixation for type III and IV supracondylar fracture of humerus in children provides a stable configuration with good functional outcomes and avoids iatrogenic ulnar nerve injury.

Keywords

supracondylar humeral fracture, pediatric, divergent, pin fixation

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