Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique

Abstract

Seventy children with displaced type II and III supracondylar fractures of the humerus were managed with percutaneous lateral cross-wiring technique from January 2006 to January 2007. There were 54 boys and 16 girls with a mean age of 6.1 +/- 3.07 years. All patients were operated within 24 h after trauma using the Dorgans percutaneous lateral cross-wiring technique. Patients were followed up for a mean period of 6.1 +/- 2.6 months and assessed both radiologically for union; and functionally and cosmetically according to Flynn's criteria. All patients achieved solid union. Functionally, all patients achieved satisfactory results, while cosmetically, 91.4% of patients had satisfactory results and 8.6% had unsatisfactory results. The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. The obtained results and minor complications reported signify this technique as a viable treatment method for displaced type II and III supracondylar fractures in children.

Does the technique of lateral cross-wiring (Dorgan’s technique) reduce iatrogenic ulnar nerve injury?

“…In our study a rate of 9% ulnar nerve damage was seen in medial and lateral cross-wire cases. However, there have been no reports of iatrogenic ulnar nerve damage from lateral cross-wire configuration [3,13]. As our cases which were treated with lateral cross-wire configuration showed no iatrogenic ulnar nerve damage, it is thought that in the treatment of paediatric supracondylar fractures, the use of lateral cross K-wires may reduce the possibility of iatrogenic ulnar nerve damage.…”

“…In recent biomechanical studies it has been shown that cross-wire pinning configuration is the most stable fixation technique [7]. Although loss of reduction is high in lateral divergent pinning at 28%, only 2% have been reported for cross-wire fixation, and no loss of reduction cases have been reported for all lateral crosswire pinning in the literature [3,13]. In our study loss of reduction was detected as 2.6% for cross-wire and 1.5% for all lateral cross-wire fixation groups.…”

“…However, there is a risk of iatrogenic ulnar nerve damage [12]. The lateral double wire technique introduced by Dorgan and used by the author since 1994 is known to achieve good stabilisation and reduce the rate of ulnar nerve damage [3,13].…”

Transolecranon and Lateral Kirschner Wire Fixation for Displaced Supracondylar Humeral Fracture in Children

“…This is comparable with other studies. 87.5% achieved satisfactory outcome after fixation using 2 lateral wires inserted through the trochlea-capitellar junction 10 ; 80% achieved satisfactory outcome after fixation using crossed medial-lateral and lateral wires 11 ; 91.4% achieved satisfactory outcome after fixation using lateral cross wires 12 ; 91.9% to 96.3% achieved excellent/good outcome after fixation using one to 2 posterior intrafocal wires 8 ; 95% to 100% achieved excellent/good outcome after a pin leverage technique for reduction and 2 to 3 lateral wires for fixation. 9 Although the transolecranon wire limits the flexion and extension of the elbow, this did not affect the final outcome as the elbow was fixed in a plasterof-Paris splint for a minimum of 3 weeks.…”

Radial nerve safety in Dorgan’s lateral cross-pinning of the supracondylar humeral fracture in children

“…We use Dorgan's technique for fixation of medial oblique fractures for which the lateral divergent Kirschner (K)-wire configuration is suboptimal [5]. Although some authors claim minimal risk for radial nerve injury by this technique, the ideal limits for safe placement of the proximal entry pin in coronal and transverse planes have not been defined on the basis of evidence [8][9][10]. This pin may, however, risk damage to the radial nerve because of its close proximity to the anterior and lateral surfaces of the distal humerus.…”