A comparative study of two percutaneous pinning techniques (Cross K wire vs Lateral K wire) for Gartland type III pediatric supracondylar fracture of the humerus

Abstract

Background: Supracondylar fractures of humerus are one of the most common fractures in paediatric age group. Closed reduction and percutaneous K-wire fixation is one of the most commonly used treatment modality in Gartland type 3 fractures. A prospective randomized controlled study was undertaken to compare whether parallel k wires are better in terms of the stability, functional outcome and iatrogenic ulnar nerve as compared to cross k wire (medial and lateral). Material and methods: This is a prospective comparative randomized controlled trial. A total of 30 patients of displaced supracondylar fracture aged between 5-13 years, without any compound injury or comminution were enrolled for the study and randomly divided into two groups, each of 15 patients. One group was assigned treatment of crossed pinning and other group with lateral pinning respectively and outcome was evaluated on basis of pain, motion, stability and function according to Mayo's elbow score and follow-up was maintained for a period of 45 days and statistical significance was calculated. Results: After assessment of 15 patients in each group we found out that mean mayo score was 98 in cross pinning group and 96.83 in lateral pinning group. This difference is statistically not significant. Conclusion: In our study we conclude that, lateral pinning is an equally good treatment choice in these fractures and especially for grossly swollen elbows. Also, risk of ulnar nerve injury during placement of medial pin is eliminated in lateral parallel k wires. Both the methods offer consistently satisfactory functional and cosmetic results.

A comparison between percutaneous cross k wire and lateral k wires fixation in management of Type III Gartland paediatric supracondylar fractures

“…Also, higher incidence in males and greater involvement on left side were seen, which is consistent with a study of 57 patients conducted by Naik et al [20] No significant difference in functional outcome was noted between either of the techniques in our study. This finding is comparable to the studies by Naik et al [20] Patil et al [21] Kocher et al [5] and Reynolds et al [22] This shows that the surgeon may choose any of the two techniques to fix the fracture as per his convenience, fracture pattern and surgical skill. Lateral k wire fixation has as good outcome as cross kwire fixation.…”

Medial–lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: a meta-analysis of randomized controlled trials

“…The incidence of iatrogenic ulnar nerve injury was compared in 18 RCTs (Table 2 ). Six studies observed no injury in all patients [ 22 , 27 , 30 , 35 – 37 ]. Among 542 fractures with crossed medial–lateral pinning, there were 22 cases suffering injury of iatrogenic ulnar nerve.…”

“…The literature search identified a total of 327 unique articles after removing duplicates. Finally, 19 RCTs comprising 1297 children with SCHF were included in current meta-analysis [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (Fig. 1).…”

Lateral Entry Pinning and Crossed Entry Pinning in Pediatric Supracondylar Humeral Fractures Gartland Type Iii

“…Prospective randomized study Vaidya et al (20) 2009 UNIVERSITY OF SEYCHELLES American Institute of medicine Prospective randomized study Patil et al (21) 2017 International Journal of Orthopaedics Sciences…”