RESEARCH ARTICLE


A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures



Murtaza K. Khwaja, Wasim S. Khan*, Pinak Ray, Derek H. Park
Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK


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© 2017 Khwaja et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Arthroplasty Fellow, Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK; Tel: +44 (0) 7791 025554; Fax: +44 (0) 20 8570 3864; E-mail: wasimkhan@doctors.org.uk


Abstract

Background:

Supracondylar fractures are common in children and are associated with significant morbidity.

The purpose of our study was to assess and compare the clinical and radiological outcome of management of supracondylar fractures by both wire configurations, along with identifying factors that predispose to complications.

Materials & Methods:

We retrospectively reviewed all paediatric cases admitted with a supracondylar fracture over a five year period. We reviewed case notes, theatre records and radiographs to determine the age of the patient, classification of fracture, treatment method, delay to theatre, duration of surgery, wire configuration, Baumann´s angle, radiocapitellar alignment, anterior humeral alignment and complications.

Results:

During the five year period we admitted 132 patients and complete notes were available for 123 patients for analyses. For all the patients managed with wire stabilisation 23% developed complications, including 13% with significant complications including nerve injuries and fracture displacements. All five nerve injuries had crossed wires, whereas all for fracture displacements had lateral wires. Baumann´s angle was 76.7 degrees in the group with no complication and 72.2 degrees in the significant complication group (p=0.02). Radiocapitellar line and anterior humeral line were not satisfactory in 5% and 15% of the group with no complications, and 17% and 33% of the group with significant complications.

Conclusion:

We found more complications in lateral pinning configurations, although all nerve injuries were in patients with crossed wire configurations. The factors we believe are associated with a higher likelihood of complications are inadequate post-operative radiological appearance.

Keywords: Retrospective, K-wire, Configuration, Supracondylar fractures, Iatrogenic nerve injury.