Original Article A Comparative Study of Percutaneous K Wire Fixation Techniques Lateral Versus Medial-lateral for Displaced Supracondylar Fracture of the Humerus in Children

A Comparative Study of Percutaneous K Wire Fixation Techniques Lateral Versus Medial-lateral for Displaced Supracondylar Fracture of the Humerus in Children

Abstract

In pediatric age group injuries; fractures around the elbow joint contribute to about 10%. Supracondylar
humeral fractures account for 50-70% of all elbow fractures. There is general accordance in the treatment of undisplaced
supracondylar humerus fractures. The controversy arises in the treatment of partially displaced and completely displaced
supracondylar fractures of humerus. The study aims to compare clinical and radiological outcome of cases of displaced
pediatric supracondylar fracture humerus treated with close reduction & k-wire fixation by cross pinning technique to that of
lateral pinning technique and to enlist various complications. Methods: A total number of 32 cases diagnosed as displaced
supracondylar fracture of humerus satisfying the inclusion and exclusion criteria were selected. The cases were collected from
both outpatient and inpatient; Department of Orthopaedics, KIMS, Hubli. The study was conducted for a period of one year
from December 2017 to December 2018. Results: In our study of 32 children with displaced supracondylar humerus fracture
mode of injury in 19 patients was fall on outstretched hand while playing[59%] & 13 patients had alleged history of road traffic
accident sustaining direct injury to elbow [41%]. Among the 32 children 6 had come before 24 hours of injury[19%], 19 visited
between 24hours to 48 hours of injury [59%]& rest 7 presented 48 hours after injury .The age group ranged from 3 to 12 years
with mean age being 7.4 years.Among 32 children 19 were males [59%] & 13 were females [41%] inferring that males are
mostly affected. Involvement of left side[56%] was more than right side [44%].the condition was classified based on Gartland
classification .None of the 32 children had any associated injuries and neurovascular status was normal. Initially the cases were
provided by primary splintage of posterior slab with 40 degree flexion .Most of the patients in our study had posteromedial
displacement [69%]and rest had postero lateral displacement [31%]. Among the 32 patients 16 underwent cross fixation[50%]
& rest 16 patients treated with lateral pinning [50%]& outcome was evaluated clinically by Modified Flynn’s criteria. Carrying
angle loss was found to be 4.31 ± 1.25 in cross pinning and 4.44 ± 1.59 in lateral pinning representing average of 4.37 ± 1.42.
The flexion loss in our study is reported to be 4.31 ± 1.40 and 4.38 ± 1.45 among cross pinning and lateral pinning group
and averaged to be 4.34 ± 1.42, respectively. Extension loss in our study is reported to be 4.13 ± 1.02 and 4.31 ± 1.82 among
cross pinning and lateral pinning groups and average comes to be 4.22 ± 1.42. The Flynn’s criteria were found [table -1] to be
Excellent in 13 [81%] among cross pinning group and 12 [75%] patients who underwent lateral pinning. Good outcome seen in
3 [19%] and 4 [25%] patients among cross pinning and lateral pinning group, respectively. Unsatisfactory result was not seen
in any patients. Radiological outcome was evaluated by Baumann’s angle loss . Average loss of Baumann’s angle is reported
to be 3.19 ± 1.42 and 3.38 ± 1.78 in lateral pinning and cross pinning group, accounts to be 3.28 ± 1.6. Excellent outcome
was noted in 15 patients each in lateral and cross pinning group. One patient each in lateral and cross pinning group had good
outcome .2 patients of cross pinning fixation had ulnar nerve palsy [6.3%]. No ulnar nerve palsy was reported in lateral pinning
fixation.One case has pin tract infection and was treated with regular dressing and local antibiotic infiltration. Conclusion:
Supracondylar humerus fracture occurs due to fall on outstretched hand or rta causing direct injury to the elbow affecting 3-12