Comparative Study of Lateral K-Wire and Crossed K-wires Fixation for the Management of Gartland Type III Closed Supracondylar Humeral Fracture.

Abstract

Supracondylar humerus fractures are one of the most common fractures in the pediatric age group. Displaced fractures are treated by closed reduction and percutaneous Kirschner-wire (K-wire) fixation in a standard situation. Cross K-wire and lateral K-wires are the commonest configurations used for closed fixation. The present study aims to evaluate the difference between the two configurations in terms of surgical technique, functional outcome, radiological outcome and complications. To assess the radiographic and functional results of lateral and crossed pinning in children with a diagnosed case of Gartland type III supracondylar humeral fractures. After the inclusion and exclusion criteria were met, a quasi-experimental study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) between July 2022 and June 2024. Immediately after admission, a detailed neurovascular examination was done. The elbow's anteroposterior and lateral radiographs were obtained and the type of fracture was recorded. The parent or guardian provided written, informed consent. Then, 40 patients were treated with the Lateral K-wire fixation (Group A) and another 40 patients with the Cross K-wire fixation (Group B) . Patients in Groups A and B had mean ages of 7.2±2.25 and 7.9±1.16 years, respectively. This difference was not found to be of statistical significance. Majorities of the patients were male in both groups and non-dominant hands were involved in both groups. The most common form of injury in both groups was trauma to the elbow during playing (42.5% in Group A and 77.5% in Group B). More operative time needed in Group B than Group A but it was not statistically significant. 7.5% iatrogenic ulnar nerve injuries occurred with cross K-wire fixation group. As per the Flynn criteria, 14 patients in Group A had excellent results, 20 patients had good results, 5 patients had fair result and 1 patient has poor result. In Group B, 10 patients had excellent results, 25 patients had good results and 5 patients had fair results. No patients in Group B had poor result. Both lateral and cross K-wire fixation are similarly effective techniques for stabilizing supracondylar humerus fractures with comparable functional, radiological and aesthetic results.