RSS-Feed abonnieren
DOI: 10.1055/s-0042-1757307
Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children[*]
Artikel in mehreren Sprachen: português | English
Abstract
Objective To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle.
Methods An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system.
Results A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases.
Conclusion The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.
Financial Support
The study was partially supported by the AO Trauma Latin America Research Office.
Author's Contributions
All authors have read and approved the final version of the article. ADNV: conception and design, analysis and interpretation, data collection, writing the article, ANF: critical revision of the article, final approval of the article, statistical analysis, overall responsibility.
* Work developed at Hospital de Trauma Manuel Giagni, Assunción, Paraguay.
Publikationsverlauf
Eingereicht: 06. März 2022
Angenommen: 17. August 2022
Artikel online veröffentlicht:
14. Oktober 2022
© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br 1975; 57 (04) 430-436
- 2 Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 2009; 29 (06) 602-605
- 3 Milch H. Fractures and fracture dislocations of the humeral condyles. J Trauma 1964; 4: 592-607
- 4 Ersan O, Gonen E, Arik A, Dasar U, Ates Y. Treatment of supracondylar fractures of the humerus in children through an anterior approach is a safe and effective method. Int Orthop 2009; 33 (05) 1371-1375
- 5 Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand 1988; 59 (04) 419-424
- 6 Toh S, Tsubo K, Nishikawa S, Inoue S, Nakamura R, Harata S. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg Am 2002; 84 (04) 593-598
- 7 Haynes RJ, Sullivan E. The Pediatric Orthopaedic Society of North America pediatric orthopaedic functional health questionnaire: an analysis of normals. J Pediatr Orthop 2001; 21 (05) 619-621
- 8 Ganeshalingam R, Donnan A, Evans O, Hoq M, Camp M, Donnan L. Lateral condylar fractures of the humerus in children: does the type of fixation matter?. Bone Joint J 2018; 100-B (03) 387-395
- 9 Schlitz RS, Schwertz JM, Eberhardt AW, Gilbert SR. Biomechanical Analysis of Screws Versus K-Wires for Lateral Humeral Condyle Fractures. J Pediatr Orthop 2015; 35 (08) e93-e97
- 10 Bloom T, Chen LY, Sabharwal S. Biomechanical analysis of lateral humeral condyle fracture pinning. J Pediatr Orthop 2011; 31 (02) 130-137
- 11 Launay F, Leet AI, Jacopin S, Jouve JL, Bollini G, Sponseller PD. Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Pediatr Orthop 2004; 24 (04) 385-391
- 12 Li WC, Xu RJ. Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Int Orthop 2012; 36 (06) 1261-1266
- 13 Tan SHS, Dartnell J, Lim AKS, Hui JH. Paediatric lateral condyle fractures: a systematic review. Arch Orthop Trauma Surg 2018; 138 (06) 809-817
- 14 Hasler CC, von Laer L. Prevention of growth disturbances after fractures of the lateral humeral condyle in children. J Pediatr Orthop B 2001; 10 (02) 123-130
- 15 Stein BE, Ramji AF, Hassanzadeh H, Wohlgemut JM, Ain MC, Sponseller PD. Cannulated Lag Screw Fixation of Displaced Lateral Humeral Condyle Fractures Is Associated With Lower Rates of Open Reduction and Infection Than Pin Fixation. J Pediatr Orthop 2017; 37 (01) 7-13