The use of the 3-mm K-Wire to supplement reduction of humeral supracondylar fractures in children.
BACKGROUND
Most children with humeral supracondylar fractures can be treated with simple closed reduction and cross-fixation with Kirschner (K)-wires. However, in a small proportion of cases, an acceptable closed reduction cannot be obtained, and open reduction becomes necessary. An alternative to open reduction is the use of a temporary 3-mm K-wire to manipulate and reduce the distal fragment. This report introduces the method of manipulation, as well as indications, and draws comparisons with complete close reduction cases.


METHODS
Of 118 patients, 76 (64.4%) were managed with the standard closed reduction method and additional K-wire fixation to secure a good alignment (group 1). In the remaining 42 cases (35.6%), acceptable reduction could not be achieved by closed methods alone, and another temporary 3-mm K-wire was used to manipulate the distal fragment. After reduction of the fracture with the additional wire, standard cross K-wires were inserted to stabilize the fracture (group 2). As long as there was contact at the fracture site in cases of humeral supracondylar fracture, the traditional closed method was used easily to achieve excellent restoration. However, for cases in which the fracture site was totally displaced, and contact at the fracture site via traction was unsuccessful, a 3-mm K-wire was used to perform supplemental restoration treatment. All the patients, after the operation, were temporally immobilized with a long-arm splint for about 3 weeks. The fixation K-wires were removed after the radiograph had shown callus formation over the fracture site. Then the operation indications, operation methods and time, complications, and differences in range of motion were analyzed for these two sets of patients.


RESULTS
The average group 1 surgery time was 18 minutes (range, 9-32 minutes), whereas the average surgery time for group 2 was 33 minutes (range, 15-45 minutes). Three cases in group 1 were complicated with ulnar nerve injury caused by the fixation wire. There were no ulnar nerve injuries in group 2. However, the ulnar nerve injury complication rates for the two groups (3 in 76 for group 1; 0 in 40 for group 2) did not reach statistical difference (p = 0.5502, Fisher's exact test). The union times for the two groups were almost the same (average, 3 weeks; range, 2-5 weeks). The 3-mm K-wire manipulation reduction cases and the closed reduction cases seemed to yield the same healing results in all aspects, except for the longer surgery time in group 2 (p < 0.0001). Both groups achieved satisfactory results.


CONCLUSIONS
The closed reduction method should be used for children with humeral supracondylar fractures, whenever possible. The 3-mm K-wire manipulation method reduces the probability that open reduction will be required in some severe cases. This is a simple method without complications. The prognosis is the same as for closed reduction cases.
Yu
Shang-Won
SW
Department of Orthopaedics, E-Da Hospital/I-Shou University, 824 Kaohsiung County, Taiwan.
Su
Juin-Yih
JY
Kao
Feng-Chen
FC
Ma
Ching-Hou
CH
Yen
Cheng-Yo
CY
Tu
Yuan-Kun
YK
D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D011859:Radiography; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries