Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children

Abstract

Introduction: This study compares the outcome of two treatment modalities of fixing neglected lateral condyle fracture of humerus in children in terms of clinical and radiological outcomes. Materials and Methods: All patients presenting to our institution were screened for eligibility by clinico-radiological evaluation. Patients were randomized into two groups i.e. Cancellous screw (CS) fixation (group I) and K wire fixation (group II). Patients were treated by open reduction and internal fixation using CS or K wires of appropriate size accordingly. (21 patients in group I and 19 patients in group II). Bone graft was used in all patients to promote osteosynthesis. Average follow up of patients was 18 months (range 11-22 months). Final outcome was measured in terms of clinicoradiological union, immobilization time, loss of reduction, gain in range of motion and functional outcome measured by Liverpool elbow score. Result: 21 patients were in group I (CS) and 19 patients were in group II (K wire). Mean age for group I and II was 7.9 and 7.5 years. Mean delay in presentation for group I and II was 14.9 and 13.2 weeks. Mean gain in range of motion (at final follow up as compared preoperatively) for group I and II was 23.5 and 17.8. Mean duration of immobilization for group I and II was 11.3 and 9.6 weeks. Mean LES score was 8.7 and 8.3 in group I and II. Union was seen in 37 cases. Three patients had pre mature physeal closure. Pin tract infection was seen in 4 patients in group II which healed by dressing and antibiotics. No patient had ulnar nerve palsy. Conclusion: Both techniques provide stable fixation, union and good functional outcome and there was no difference in the LES, however less immobilization and improvement in range of motion was seen in Group I (CS)